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At least 523 records · Page 29Linked to original sources
PubMed2006

In vitro effects of 3 common arthroscopic instruments on articular cartilage.

PURPOSE: The purpose of this study was to compare chondroplasty performed with an ExoJet high-pressure fluid-driven burr (Mitek, Norwood, MA), a mechanical shaver, and a bipolar radiofrequency (RF) wand on articular cartilage-covered condyles taken from sheep cadavers that were induced to have an osteoarthritic-like condition, and corresponding healthy control tissue. TYPE OF STUDY: Experimental designed animal cadaveric, biochemical, and histologic study. METHODS: Sheep condyles were used as a source of articular cartilage. Femurs were extracted approximately 1 hour postmortem and a transverse section of the condyles was made. Half of the samples were treated to induce an osteoarthritic-like condition. The condyles were then subjected to chondroplasty performed with the ExoJet high-pressure fluid-driven burr, a mechanical shaver, and a bipolar RF wand under sterile saline solution by an experienced orthopaedic surgeon. Twenty cross-sections from each condyle were examined by confocal microscopy to measure smoothness and depth of tissue damage to the articular cartilage caused by each of the 3 instruments. RESULTS: The ExoJet high-pressure fluid-driven burr and the bipolar RF wand left a smoother surface on the articular cartilage compared with the mechanical shaver. Additionally, the ExoJet fluid-burr caused slightly less tissue damage to the cartilage than the bipolar RF wand, both of which were less damaging than the shaver. CONCLUSIONS: Orthopaedists have multiple choices for surgical instruments used on cartilage. However, the effect on the integrity of the cartilage left remaining at the knee was previously unknown. Based on this study, a fluid-burr appears to leave the cartilage with a smaller zone of injury than does the RF wand or shaver. It also leaves the cartilage surface smoother than the shaver. During surgical procedures, minimizing cartilage breakdown and smooth remaining surfaces are desired because they minimize the vulnerable tissue to further destruction. A fluid burr leaves cartilage with less injury and with a smoother surface than do more traditional surgical instruments. CLINICAL RELEVANCE: This information should help surgeons in their selection of currently available surgical instruments and should aid engineers in the design of future instruments that function to modify articular cartilage.

Animals↗
PubMed1999

Evaluation of a telerobotic system to assist surgeons in microsurgery.

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.

Evaluation Studies as Topic↗
PubMed1984

Anal erotic instrumentation. A surgical problem.

Anal sexual eroticism is a fact of modern life and a part of the male homosexual relationship. A delineation of surgical problems associated with anal erotic instrumentation with enema is presented. The cases of three patients with rectal perforation are described.

Adolescent↗
PubMed1994

Measurement of soft tissue imbalance in total knee arthroplasty using electronic instrumentation.

The existence of soft tissue contractures in arthritis and the presence of soft tissue imbalance at the time of a total knee arthroplasty causing deformity in the coronal plane has been debated extensively. This discussion was based on the use of instrumentation which tensed the medial and lateral soft tissues in an uncontrolled manner during the operation. Previous work by this research team has developed a surgical instrument to quantify soft tissue imbalance independently of the compressive passive loads through the knee. In order to validate this assumption, an electronic measuring system was developed to record the soft tissue imbalance at 0.25 mm distraction intervals of the knee. This soft-tissue measuring system consists of a surgical instrument containing electronic transducers, an analogue conditioning unit and a portable computer. The surgical instrument introduces a pivot to the centre of the knee in the coronal plane so that the clockwise and counterclockwise moments produced by the collateral soft tissues produce an angular deviation at the equilibrium position. Measurements of angular deviation and separation gap are recorded by the electronic transducers. Eight patients were measured whilst undergoing total knee replacement at Bretby Hall Orthopaedic Hospital. The mean change in angular deviation over an average distraction of the knee of 7.15 mm was 0.4 degrees with a standard deviation of 0.4. It is concluded that this is an acceptable error band for surgical measurement, and soft tissue imbalance can be defined as angular deviation independently of the passive compressive loads through the knee.

Anthropometry↗
PubMed2003

Responsiveness of the National Eye Institute Refractive Error Quality of Life instrument to surgical correction of refractive error.

OBJECTIVE: Refractive error and the means by which it is corrected may impact substantially on quality of vision and health-related quality of life in ways not captured adequately by standard measures of visual acuity. The goal of this analysis was to evaluate the responsiveness of the National Eye Institute Refractive Error Quality of Life (NEI-RQL) instrument to surgical correction of refractive error. DESIGN: Prospective, multicenter cohort study. PARTICIPANTS: The NEI-RQL, a 42-item measure with 13 scales, was self-administered by 185 patients before and after undergoing surgical correction of myopic or hyperopic refractive error. Preoperative and postoperative clinical information was collected, including refractive error and corrected visual acuity. METHODS: Differences between preoperative and postoperative NEI-RQL scores were examined. Responsiveness was assessed using the standardized response mean and the responsiveness statistic. We also compared scales using relative efficiency estimates. MAIN OUTCOME MEASURES: Changes in NEI-RQL scales (clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limitations, glare, symptoms, dependence on correction, worry, suboptimal correction, appearance, and satisfaction with correction). RESULTS: For myopes and hyperopes combined, refractive surgical correction was associated with statistically significant (P<0.05) improvements in scores for 11 of 13 scales. The largest improvements, ranging from 26 to 58 points on the 0 to 100 possible score range, were seen in expectations, activity limitations, dependence on correction, appearance, and satisfaction with correction. Separate analysis of myopes and hyperopes revealed similar effects in the 2 groups. Baseline scores were found to be predictive of change after surgery. CONCLUSIONS: The NEI-RQL is responsive to changes in vision-targeted health-related quality of life resulting from keratorefractive surgery. This instrument may prove useful for evaluating the beneficial and adverse impacts of surgical and nonsurgical methods of refractive error correction.

Adult↗
PubMed2003

[Crystotomy with use of surgical ultrasonic instruments].

The authors propose to make crystotomy using energy of low-frequency ultrasound (the device URSK 7N 22, frequency - 26.5-30 kHz, amplitude - 40-50 mcm). The working part of the waveguide was designed in specific geometric shape. Indications to ultrasonic crystotomy and surgical techniques are outlined. A total of 29 patients were operated on. Good results were achieved in 25 patients, satisfactory results in 4 patients.

Equipment Design↗
PubMed2002

A virtual fluoroscopy system and its use for image guidance in unicompartmental knee surgery.

The C-arm fluoroscope is an indispensable intraoperative 2D imaging device for orthopaedic surgery. However, its frequent use in an operation presents a significant radiation hazard to the theatre staff and patient. A recent technique known as virtual fluoroscopy (VF) enhances the fluoroscope's capability for image guided surgery by tracking optically the position of the C-arm, surgical instruments and the patient. Virtuality is achieved by overlay of surgical instruments onto one or more previously captured fluoroscopic images. A key benefit of VF is that it reduces considerably the radiation hazard. This paper reports on a new VF technique for tracking and calibration of the fluoroscopic C-arm. Also reported is the use of our VF system to provide a new image guided technique for the accurate placement of the femoral component of unicompartmental knee prosthesis.

Arthroplasty, Replacement, Knee↗
PubMed1993

Computer-assisted orbital surgery.

In orbital surgery, deep lesions must be operated on through extremely small approaches. We developed a method (Computer Assisted Surgery or CAS) designed to achieve safer and more precise surgery by providing highly accurate intraoperative information regarding the location of the surgical instrument. The device involved consists of a high-capacity computer that processes computed tomographic (CT) data in real time, connected to a mechanical measuring arm attached to the surgical instrument. From the CT data, the computer calculates a three-dimensional reconstruction and displays the tip of the instrument as a reticle in this model. Using the CAS system, the surgeon is continuously apprised of the precise position of the surgical instrument vis-a-vis all relevant anatomical structures. We have used CAS successfully in 21 cases of orbital surgery. We have found the system especially useful in dealing with deep-seated tumors, either for biopsy or surgery; in performing orbital and optic nerve decompression; in localizing deep-seated foreign bodies; and in all cases of impaired orientation due to severe bleeding, tumor-destroyed landmarks, or preoperated anatomy. Although the number of patients is too small to yield statistically significant data allowing a comparison of patient outcomes with and without using the system, we have just begun a large prospective clinical trial designed to provide such data.

Adolescent↗
PubMed1989

Production problem encountered using a solvent drying plant.

All dirty surgical instruments received into the unit are processed through an Automatic Surgical Instrument Cleaning and Solvent Drying System. This system had been in continuous use since its installation in August 1983 until May 1986, without any significant production problem arising. During May 1986, and for a prolonged period afterwards, persistent separation of the surfactants contained in the Arklone W occurred. This separation manifested itself as a thick Cheeselike surface scum on the cooled solvent. At the onset the only recourse available in order to maintain the plants productive capacity was to replace the contaminated solvent with fresh following each occurrence. This constant replenishment obviously proved to be an extremely time consuming exercise. No additional material cost was involved as ICI readily supplied all the solvent requirement completely free of charge throughout the whole period.

Central Supply, Hospital↗
PubMed2006

[Basic concept in computer assisted surgery].

OBJECTIVE: To investigate application of medical digital imaging systems and computer technologies in orthopedics. METHODS: The main computer-assisted surgery systems comprise the four following subcategories. RESULTS: (1) A collection and recording process for digital data on each patient, including preoperative images (CT scans, MRI, standard X-rays), intraoperative visualization (fluoroscopy, ultrasound), and intraoperative position and orientation of surgical instruments or bone sections (using 3D localises). Data merging based on the matching of preoperative imaging (CT scans, MRI, standard X-rays) and intraoperative visualization (anatomical landmarks, or bone surfaces digitized intraoperatively via 3D localiser; intraoperative ultrasound images processed for delineation of bone contours). (2) In cases where only intraoperative images are used for computer-assisted surgical navigation, the calibration of the intraoperative imaging system replaces the merged data system, which is then no longer necessary. (3) A system that provides aid in decision-making, so that the surgical approach is planned on basis of multimodal information: the interactive positioning of surgical instruments or bone sections transmitted via pre- or intraoperative images, display of elements to guide surgical navigation (direction, axis, orientation, length and diameter of a surgical instrument, impingement, etc. ). And (4) A system that monitors the surgical procedure, thereby ensuring that the optimal strategy defined at the preoperative stage is taken into account. CONCLUSION: It is possible that computer-assisted orthopedic surgery systems will enable surgeons to better assess the accuracy and reliability of the various operative techniques, an indispensable stage in the optimization of surgery.

Humans↗
PubMed2006

Are surgical stainless steel wires used for intracranial implantation of PrPsc a good model of iatrogenic transmission from contaminated surgical stainless steel instruments after cleaning?

Transmissible spongiform encephalopathies are a group of fatal, neurodegenerative diseases commonly known as prion diseases. Prion diseases can resist traditional inactivation strategies and may be iatrogenically transmitted by surgical instruments through the human population. These properties have led to the need for a suitable detection method of the prion infectious agent, and increased pressure regarding the development of anti-prion cleaning methodologies that would ensure the safety of surgical instruments. Although other techniques have been applied, the animal bioassay remains the 'gold standard' method for assessing infectivity. As the vast majority of surgical instruments are made of stainless steel, and in order to test this surface using the animal bioassay, the application of very thin surgical stainless steel wires has been widely adopted. These wires are easily inoculated and may be reimplanted into animals without the requirement for elution of the residual material. However, their comparability to the dimensions, shape and size of surgical instruments is questionable. This article shows how such contaminated wires (residual protein between 6.3 and 16.0 ng/mm(2)) can be cleaned more easily than flat metal surfaces (residual protein between 63.9 and 89.3 ng/mm(2)) under comparable conditions using recommended cleaning agents. These results indicate that the application of wires as a realistic means of assessing the removal or inactivation of the prion infectious agent from surgical instruments should be treated with caution.

Animals↗
PubMed2006

Producing diffuse ultrasound reflections from medical instruments using a quadratic residue diffuser.

Simultaneous visualization of tissue and surgical instruments is necessary during ultrasound-guided medical procedures. Standard minimally invasive instruments are typically metallic and act as strong specular scatterers. As a result, such instruments saturate the image or disappear according to the angle of incidence, obscuring nearby tissue and making it difficult to determine the instrument's precise location. The objective of this study was to produce diffusive reflections from the surface of surgical instruments for improved visualization in ultrasound. A surface profile based on a 2D quadratic residue diffuser (QRD) was employed, which has been demonstrated to reduce specular reflection in other acoustic applications. The backscattered echo amplitude from the diffusive surface at various angles of insonation was measured and compared to that from unmodified metal surfaces and heart tissue surfaces. The QRD resulted in an 8 dB reduction of the specular signal. Furthermore, the dynamic range for angles up to 75 degrees was less than 20 dB for the QRD and more than 65 dB for a flat surface. The QRD surface produces two beneficial results for the simultaneous imaging of instruments and tissue. First, the conspicuity of diffusive surfaces in ultrasound images is markedly improved in comparison with unmodified metal surfaces. Secondly, the echo amplitude of diffusive metal surfaces differs in mean and standard deviation from that of tissue facilitating image enhancement and segmentation.

Acoustics↗
PubMed2005

Urogenital surgery of the 15th century in Anatolia.

PURPOSE: We examined the urological procedures of the 15th century covered in the surgery textbook, Cerrahiyyetu'l Haniyye. MATERIALS AND METHODS: Three copies of the surgery textbook, Cerrahiyyetu'l Haniyye (Sultan's Surgery), by Serefeddin Sabuncuoglu, who lived in Turkey between 1385 and 1470, were evaluated. The colorfully miniaturized and illustrated textbook, written 536 years ago, covers a number of surgical disciplines, including urology. We evaluated urological sections with regard to the type of procedures, definitions and approaches for certain diseases and surgical tools used for urological operations. RESULTS: The textbook reviews the surgical treatment of urological conditions such as varicocele, hydrocele, hermaphroditism, imperforated urinary meatus, meatal stenosis, hypospadias, penile and scrotal lesions, and circumcision techniques. It includes definitions of diseases, etiologies and surgical therapies, and describes surgical instruments. The author also illustrated surgical approaches and instruments. CONCLUSIONS: A treasure trove of surgical knowledge, Cerrahiyyetu'l Haniyye has enlightened urologists from the 15th century to the present day.

Female↗
PubMed1994

Surgical reporting instrument designed to improve outcome data in head and neck cancer trials.

Precise reporting of surgical staging and operative data in multi-institutional protocol studies could provide a number of benefits: 1) fewer cases would be discarded because of inadequate data, 2) staff review time would be reduced, 3) there would be assurance that participating surgeons were performing similar operations on similar tumors, 4) the resulting precision in stratification should improve the likelihood of achieving accurate comparison of the treatment options under study, and 5) by comparing the surgical parameters with local-regional control of disease, the specific factors that have a statistically significant correlation with outcome could be identified. This paper presents a computer-based, anatomically oriented reporting instrument that should improve the reliability of surgical data available to multi-institutional protocols.

Clinical Trials as Topic↗
PubMed1986

The fetal visual evoked potential.

Five singleton fetal lambs were surgically instrumented at 110-121 days gestation (term gestation = 145 days) for measurement of visual evoked potentials (VEP) in utero. Light flashes were generated by a small incandescent bulb secured under the right fetal eyelids and the visual responses were recorded through stainless steel electrodes implanted in the fetal scalp. Four of the five fetal lambs were surgically instrumented between 110-113 days. VEPs recorded in these four animals from 111-114 days exhibited N1, P1, and N2, but lacked the P2 component. All VEP components (N1, P1, N2, P2) were measureable by 115-118 days in these fetuses. One fetus was surgically instrumented at 121 days and VEPs containing all components were measurable until 125 days gestation when the equipment dislodged in utero. Serial VEP recordings from all five fetal lambs from 111-128 days indicated no change in latency to N1 while significant latency changes occurred in P1, N2, and P2 suggesting maturational development of the visual system. Histological assessment of the eyes from three animals at delivery revealed only thickening and increased vascularity of the cornea in response to the light source resting on the fetal eye. In conclusion, these results suggest that the fetal visual evoked potential has application in the longitudinal study of normal visual development in utero and offers a technique for studying visual response changes to adverse perinatal events.

Animals↗
PubMed2006

Variability of spinal instrumentation configurations in adolescent idiopathic scoliosis.

Surgical instrumentation for the correction of adolescent idiopathic scoliosis (AIS) is a complex procedure involving many difficult decisions (i.e. spinal segment to instrument, type/location/number of hooks or screws, rod diameter/length/shape, implant attachment order, amount of rod rotation, etc.). Recent advances in instrumentation technology have brought a large increase in the number of options. Despite numerous clinical publications, there is still no consensus on the optimal surgical plan for each curve type. The objective of this study was to document and analyse instrumentation configuration and strategy variability. Five females (12-19 years) with AIS and an indication for posterior surgical instrumentation and fusion were selected. Curve patterns were as follows: two right thoracic (Cobb: 34 degrees, 52 degrees), two right thoracic and left lumbar (Cobb T/L: 57 degrees/45 degrees, 72 degrees/70 degrees) and 1 left thoraco-lumbar (Cobb: 64 degrees). The pre-operative standing postero-anterior and lateral radiographs, supine side bending radiographs, a three-dimensional (3D) reconstruction of the spine, pertinent 3D measurements as well as clinical information such as age and gender of each patient were submitted to six experienced independent spinal deformity surgeons, who were asked to provide their preferred surgical planning using a posterior spinal approach. The following data were recorded using the graphical user interface of a spine surgery simulator (6x5 cases): implant types, vertebral level, position and 3D orientation of implants, anterior release levels, rod diameter and shape, attachment sequence, rod rotation (angle, direction), adjustments (screw rotation, contraction/distraction), etc. Overall, the number of implants used ranged from 11 to 26 per patient (average 16; SD +/-4). Of these, 45% were mono-axial screws, 31% multi-axial screws and 24% hooks. At one extremity of the spectrum, one surgeon used only mono-axial screws, while at the other, another surgeon used 81% hooks. The selected superior- and inferior-instrumented vertebrae varied up to six and five levels, respectively (STD 1.2 and 1.5). A top-to-bottom attachment sequence was selected in 61% of the cases, a bottom-up in 29% and an alternate order in 11%. The rod rotation maneuver of the first rod varied from 0 degrees (no rotation) to 140 degrees, with a median at 90 degrees. In conclusion, a large variability of instrumentation strategy in AIS was documented within a small experienced group of spinal deformity surgeons. The exact cause of this large variability is unclear but warrants further investigation with multicenter outcome studies as well as experimental and computer simulation studies. We hypothesize that this variability may be attributed to different objectives for correction, to surgeon's personal preferences based on their previous experience, to the known inter-observer variability of current classification systems and to the current lack of clearly defined strategies or rational rules based on the validated biomechanical studies with modern multi-segmental instrumentation systems.

Adolescent↗