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At least 541 records · Page 30Linked to original sources
PubMed2003

[The application of an optical navigation system in endonasal sinus surgery].

BACKGROUND: There are several CAS-systems in use in modern endonasal sinus surgery. The VectorVision Compact is the first optoelectrical system especially designed for such surgery. This paper investigates its reliability and practicability. PATIENTS AND METHODS: The system was used for intraoperative navigation in 60 patients suffering from chronic rhinosinusitis. The accuracy was measured by visual estimation and compared with other navigated systems. RESULTS: The accuracy was 1.9 mm which is comparable to other systems on the market. Navigation was successful and reliable in 83.3% of the patients. Problems occurred mainly due to loss of sight of the referencing balls and when using other surgical instruments. CONCLUSION: The VectorVision Compact was adequate for endonasal sinus surgery. Further improvements incorporating various surgical instruments should broaden its clinical usefulness.

Endoscopes↗
PubMed2002

Endoscopic removal of third ventricular tumors: a technical note.

OBJECT: An endoscopic surgical technique utilizing a rollable vinyl tube as a surgical corridor is described for removal of third ventricular tumors. SURGICAL TECHNIQUE: Transcortical transventricular access is made via a burr hole placed at the point which is one inch lateral from the midline at the coronal suture area. A one-cm-diameter vinyl tube is slit longitudinally, rolled like a cigarette, and tied at its ventricular end with a release tie. With image-guided stereotactic assistance, this rolled vinyl tube is inserted into the lateral ventricle near the foramen of Monro. When the release tie is untied, the vinyl tube expands to its original 10-mm-diameter tube by recoil assisted with a balloon dilatation technique. Through this tube, a rod-lens endoscope is placed to visualize the surgical target and is mounted to an endoscope holder. Surgical instruments are inserted next to the endoscope for surgical dissection. Compared to endoscopy through fixed working-channel devices, this technique allows increased flexibility for the surgeon when maneuvering surgical instruments for delicate dissection and tumor removal. Two patients with colloid cysts and one patient with an epidermoid tumor are reported as demonstrative cases. CONCLUSION: An endoscopic technique utilizing a soft vinyl tube which can be rolled into a small diameter and then unrolled to its original size by its own recoil when a release tie is removed and by balloon dilatation, is reported for removal of third ventricular tumors.

Adult↗
PubMed1979

The autosuture surgical stapling instruments: preliminary experience.

Stapling instruments for gastrointestinal surgery are relatively new in the surgical armamentarium of Australian surgeons. In an attempt to assess their safety and handling characteristics laboratory experience has been obtained in dogs. This has shown that these instruments are effective and easily handled, although costly in routine use. It seems likely that they will provide an appropriate alternative to certain conventional anastomotic techniques.

Animals↗
PubMed2002

[New master arm for transurethral resection with a robot].

OBJECTIVE: In 1998, we designed a robot for transurethral resection that consisted of a master arm and a slave arm that reproduced the movements of the master. We describe the innovative master arm developed in two university departments that supersedes the mere "joystick" concept to become a true, operative surgical instrument. METHODS: The new master arm was developed from a conventional resectoscope working element integrated into a robotic manipulative device and fitted with angular displacement sensors. Each sensor, part of a computer-controlled feed back system commands the position and movements of the slave arm which, in turn, move the resectoscope. The surgeon freely chooses and manages precisely within a three-dimensional surgical field four basic resectoscope maneuvers; horizontal and vertical displacement, penetration-withdrawal, and rotation; he also controls the movements and operation of the resectoscope cutting loop. Additional computer-programs provide the surgeon with an error-free, fail-safe surgical instrument that denies any movements outside the planned surgical field. RESULTS: The fact that the new easily used instrument is similar in shape and works like conventional resectoscopes greatly helps familiarization and training. Advanced technology reduces the number of errors usually associated with fatigue or inexperience of the surgeon. CONCLUSIONS: The new surgical instrument handles just like conventional instruments so surgeons do not need to change their usual operating procedures. In addition, an early-warning program detects instantly and denies inappropriate maneuvers. This facility confers peace of mind to the surgeon and ensures patient satisfaction.

Equipment Design↗
PubMed2005

Newly developed endoscopic instruments for the removal of intracerebral hematoma.

Ultra-early surgical treatment in which associated brain injury is minimized and maximal volume of hematoma is removed shortly after onset with secure hemostasis is expected to be established. We developed a transparent guiding sheath and other surgical instruments for endoscopic surgery and established a novel, ultra-early stage surgical procedure using those instruments. This procedure has the following characteristics: (a) burr hole opening under local anesthesia is possible; (b) a transparent sheath improves the visualization of the surgical field in the parenchyma and the hematoma; (c) free-hand surgery without fixing an endoscope and a sheath to a frame facilitates three-dimensional operation; (d) secure hemostasis by electric coagulation is possible; (e) relatively simple surgical instruments are easy to prepare. We have performed this procedure in 82 patients with intracerebral or intraventricular hemorrhage (44 with putaminal hemorrhage, 12 with thalamic hemorrhage, 8 with subcortical hemorrhage, 8 with cerebellar hemorrhage, 10 with intraventricular hemorrhage). Twenty-four of those patients received our treatment in the ultra-early stage (within 3 hours after onset). The mean duration of surgery was 63 minutes, the mean hematoma reduction rate was 96%, and no peri-operative hemorrhage with deterioration of symptoms and/or signs occurred. Therefore, we believe that endoscopic hematoma evacuation with our surgical procedure is a promising ultra-early stage treatment for intracerebral hemorrhage and that it may improve the long-term prognosis in patents with intracerebral hemorrhage.

Equipment Design↗
PubMed2006

Endoscopic surgery with powered instrumentation for isolated sphenoid sinus disease.

OBJECTIVE: Isolated sphenoid sinus disease (ISSD) is a relatively uncommon disease. In this study, we investigate the diagnosis and pathology of ISSD and compare endoscopic treatment with powered instrumentation with conventional surgical instruments for ISSD. METHODS: Ninety-six out of 2,263 patients who underwent endoscopic surgery were diagnosed with ISSD by nasal endoscopy and computed tomography scan. Ninety-six cases of confirmed ISSD were treated by endoscopic sphenoidotomy, of which 44 cases were operated using powered instrumentation and 52 using conventional instruments. All patients were followed up for a period ranging from 18 to 54 months (mean 26 months) and the surgical outcomes were retrospectively reviewed. RESULTS: The pathological findings of these patients included sphenoid sinusitis, fungal disease, sphenoid cyst, inverted papilloma, malignant tumor, sphenoid polyp, and foreign body. The most common initial symptom was headache, followed by visual changes and nasal symptoms. After endoscopic surgery, drainage of the sphenoid was accomplished in 87 of the 96 patients (91%). Of all patients, 9.4% (9/96) had recurrent incidence, 22% (21/96) sphenoid ostium synechia, and 51% (49/96) partial middle turbinectomy. Comparing the surgical outcomes between two operative approaches, recurrent incidence, sphenoid ostium synechia, and partial middle turbinectomy were significantly lower in the powered instrumentation group (2, 7, and 14%) than in the conventional instrument group (15, 35, and 83%;p < 0.05). No serious complication occurred in either group. CONCLUSIONS: Powered instrumentation is more effective than conventional instruments in the treatment of ISSD and provides a minimally invasive surgical approach to the sphenoid sinus.

Adolescent↗
PubMed1993

Protecting patients, personnel, instruments in the OR.

The AORN "Recommended practices for care of instruments, scopes, and powered surgical instruments" should be followed: Decontamination of instruments should occur immediately after completion of the surgical procedure. Following initial decontamination by manual or automatic decontamination, instruments should be processed in an ultrasonic cleaner. Nurses should review the equipment available for decontamination and ask themselves the following questions. Are instruments being cleaned thoroughly? Does the decontamination system clean the item in a timely manner? Is precleaning of instruments necessary? Does the system save time? Is there an adequate area for decontamination? If the answers to any of these questions are debatable, nurses should reevaluate their present decontamination system. Regarding sterilization, nurses should ask the following questions. Are instruments routinely flash sterilized? Does the current procedure follow the Centers for Disease Control and Prevention recommendations for sterilizing instruments that will invade the body and enter sterile areas? Are instruments being damaged? Does the current method of sterilization offer quick turn-around time? Proper instrument processing is part of an effective infection control program. It is an important way to protect your patients from harm.

Decontamination↗
PubMed1994

[GRIN-endoscopy for laser treatment in ophthalmology].

Endoscopes for use in ophthalmology can be manufactured with diameters smaller than 0.89 mm. Because gradient-index (GRIN) lenses yield a higher resolution than ordered fiber bundles having the same diameter, GRIN lenses with a diameter of either 0.35 mm or 0.50 mm were utilized to manufacture thin high resolution endoscopes. Whatever the working distance, the resolution obtained with a GRIN lens having a diameter of 0.50 mm was higher than that obtained with a GRIN lens of 0.35 mm. Thanks to the miniaturization, an additional working channel could also be integrated within the endoscope. This allowed new combinations of various surgical instruments. This channel can be used as a guide for an optical fiber for laser therapy or as an irrigation/aspiration channel. The use of such an instrument where the observation path is parallel to the surgical instrument was compared to the application of the endoscope as a separate monitoring system. The advantages and inconveniences of both systems are discussed. Preference is given to a system where the diameter of the observation channel is maximum and the optical fiber for laser delivery is integrated but adjustable along its length within the endoscope.

Endoscopes↗
PubMed2005

Shaver, bipolar radiofrequency, and saline jet instruments for cutting meniscal tissue: a comparative experimental study on sheep menisci.

PURPOSE: The purpose of this study was to compare the quality of meniscal tissue cut with 3 different surgical instruments (traditional shavers, bipolar radiofrequency (RF) wands, and a high-pressure saline jet) and that of control menisci. TYPE OF STUDY: Experimental design, biochemical and histologic study. METHODS: Sixty samples of sheep menisci were separated into 4 groups. Three groups were shaved on the apical surface with the different instruments. The smoothness of the cut surfaces was evaluated visually by an orthopaedic surgeon and then scored by laser scanning cytometry and by line measurement analysis. The depth of tissue damage was measured by fluorescent cytochemistry. Means and standard deviations were calculated and comparative statistics used (P < .05). RESULTS: The edges cut by the saline jet and bipolar RF were significantly smoother when judged by the surgeon than those cut by traditional shaver. There was no significant difference between the saline jet and bipolar RF. There were no significant differences in smoothness when measured by laser scanning cytometry or by line measurement techniques. The control menisci had less depth of damage along the edge as measured by fluorescent cytochemistry than did any of the menisci cut with the instrument. The saline jet had significantly less depth of damage than did the shaver. No other significant differences existed between the instruments for depth of damage. CONCLUSIONS: The results of our investigation conclude that high-pressure saline instruments may cause less damage to residual meniscal tissue when compared with bipolar RF and shavers. Saline jets and bipolar RF also produce a smoother cut than shavers. CLINICAL RELEVANCE: Surgeons may want to consider the degree of residual damage to meniscal tissue from the application of various surgical instruments. Saline jets may be a superior cutting instrument than RF or shavers when considering depth of residual damage and smoothness of residual meniscal edges.

Animals↗
PubMed1982

Effects of sterilization on periodontal instruments.

The sharpness of surgical instruments is of particular importance to the periodontist. In order to study the effects of sterilization on the cutting edges of periodontal curets and scalers, new sharpened instruments were sterilized 10 cycles with saturated steam, formalin-alcohol vapor or dry heat. The instruments were evaluated before and after sterilization with a scanning electron microscope. No visual damage to the cutting edges of stainless steel instruments was evident after sterilization by saturated steam at 250 degrees F, formalin-alcohol vapor at 270 degrees F or dry heat up to 340 degrees F. Carbon steel instruments were not damaged by formalin-alcohol vapor at 270 degrees F or dry heat up to 340 degrees F. Saturated steam caused oxidation and dulling of carbon steel instruments.

Carbon↗
PubMed2002

In vivo measurement of surgical gestures.

Virtual reality techniques are now more and more widely used in the field of surgical training. However, the realism of the simulation devices requires a good knowledge of the mechanical behavior of the living organs. To provide perioperative measurement of laparoscopic surgical operations, we equipped a conventional operating grasper with a force sensor and a position sensor. The entire apparatus was connected to a PC that controlled the real-time data acquisition. After calibrating the sensors, we conducted three series of in vivo measurements on animals under video control. A standardized protocol was set up to perform various surgical gestures in a reproducible manner. Under these conditions, we can assess an original tool for a quantitative approach of surgical gestures' mechanics. The preliminary results will be extended by measurements during other operations and with other surgical instruments. The in vivo quantification of the mechanical interactions between operating instruments and anatomical structures is of great interest for the introduction of the force feedback in virtual surgery, for the modeling of the mechanical behavior of living organs, and for the design of new surgical instruments. This quantification of manipulations opens new prospects in the evaluation of surgical practices.

Animals↗
PubMed1982

[Risk of infection in instrumental and surgical urologic interventions with special reference to catheter drainage].

The risk of infection in instrumental and operative urological surgery is particularly high in the use of catheter drainage. Dependent on the duration of use of a fistula catheter or a transurethral catheter, infection of the urinary tract occurs in almost 100% of cases. The pathogens of hospital infection show a clearly increasing drug resistance. The occurrence of multiple resistances is remarkable. Furthermore, fluctuations in the range of pathogens can be detected. An increase of infection by Proteus and Klebsiella and a decrease of infections of the urinary tract with Escherichia coli and staphylococci have been observed. Prophylactic administration of chemotherapeutic agents cannot prevent the recurrence of iatrogenic infections of the urinary tract.

Adult↗
PubMed1997

Glabellar approach: simplified midline anterior skull base approach.

As a simplified microsurgical technique for lesions at the midline anterior skull base, a glabellar approach through a small incision (5 cm) between the eyebrows crossing the nasion was developed in four cadaver dissections. To determine the ideal positioning of the patient, the angle of the surgical trajectory was measured in the sagittal plane. In an effort to make an operation simple and accurate through this limited exposure, measurements were made in distance from the midline nasion to various intradural structures. Average distance from the midline point of the nasion (MPNa) to the midline of the tuberculum sella was 6.37 +/- 0.29 cm, 6.98 +/- 0.26 cm to the midline of the optic chiasm, and 8.00 +/- 0.11 to the lamina terminalis. In addition, measurements to other various anatomical landmarks were made. The angle of the line drawn from the MPNa to the midline of the tuberculum sella was 5.2 +/- 1 degrees against a line drawn between the lateral canthus and the tragus (LC-T) in the sagittal plane. Based upon this study, the positioning of the patient's head would be better if the LC-T line is positioned at 25 degree extension when the operating microscope is set at 20 degree inclination. Within 6 to 8 cm in depth from the MPNa, important landmarks are exposed without brain retraction. If surgical instruments are marked with ruler calibration, the depth of the surgical instruments will suggest the anatomical location. This glabellar approach has been used in three patients successfully. A brain retractor was not necessary and not used during the operations. This technique provides key exposures to the midline anterior skull base.

Adult↗
PubMed1986

Sterile hypopyon secondary to ultrasonic cleaning solution.

During a 20-week period, 21 cases of sterile hypopyon occurred 24 hours after uncomplicated extracapsular cataract extraction and in-the-bag posterior chamber intraocular lens implantation at the Valley Eye Institute. While all cases responded to steroid treatment and exhibited no residual ocular effects, the cause of the hypopyon remained a mystery despite an on-going reevaluation of the surgical procedure and sterilization techniques. Several suspected causes were investigated and eliminated. It was clinically determined that surgical instruments placed in older ultrasonic cleaning solution caused the hypopyons. Further analysis at the Center for Intraocular Research at the University of Utah revealed that the instruments were contaminated by a heat-stable endotoxin that remained on the instruments through the autoclaving process. Surgeons currently using ultrasonic instrument cleaners should be aware that, with some models, following the manufacturer's recommended fluid changing procedures could result in endotoxic contamination of surgical instruments which could, in turn, cause severe inflammatory reactions in the immediate postoperative period.

Animals↗
PubMedDate not supplied

Subtotal colectomy with surgical stapling instruments via a trans-cecal approach for treatment of acquired megacolon in cats.

Surgical stapling equipment was used to perform an end-to-end colonic anastomosis in 15 cats for the treatment of acquired megacolon. An end-to-end stapling device was passed to the anastomotic site by a trans-cecal approach. Subsequent closure of the cecal incision was accomplished with a thoracoabdominal stapling device. Two cats had hemorrhagic episodes immediately after surgery that required blood transfusions. All 15 cats have had good to excellent health after subtotal colectomy and colocolostomy performed using this stapling technique. Results of this study have demonstrated that "single surgical field" placement of the end-to-end stapling device has the primary advantage of simplicity and a lower chance of contamination compared with (dual field) rectal passage of similar devices. Closure of the cecal access incision is easily performed without reducing the diameter of the large intestinal lumen. The stapling technique provided an efficient and consistent method for anastomosis of the large bowel in cats.

Anastomosis, Surgical↗
PubMed1993

Gasless laparoscopy and conventional instruments. The next phase of minimally invasive surgery.

OBJECTIVE: To assess the capability of a retractor system that permits laparoscopic surgery without pneumoperitoneum and to determine if the system facilitates the use of conventional surgical instruments during minimally invasive surgery. DESIGN: Prospective evaluation and data collection with review. SETTING: University-affiliated county hospital. PATIENTS: Twenty-nine male and 29 female subjects evaluated prospectively via 27 trauma-related and 31 elective procedures. METHODS: Fifty-eight laparoscopic procedures were performed between July 1992 and February 1993 with a system consisting of an intra-abdominal fan retractor and an electrically powered mechanical arm using conventional surgical and laparoscopic instruments. RESULTS: Gasless laparoscopy was used in the evaluation of 27 patients with abdominal trauma (11 gunshot wounds, 11 stab wounds, and five blunt injuries). The need for celiotomy was obviated in 20 (74%) of 27 cases. Three enterotomies, two diaphragmatic lacerations, and one gastric perforation were repaired with conventional instruments. Gasless laparoscopic techniques were also used in cholecystectomy (n = 26), diagnostic laparoscopy (n = 3), and appendectomy (n = 2). Exposure similar to that obtained by pneumoperitoneum was obtained in 30 (97%) of 31 cases. One major (trocar tip enterotomy) and two superficial wound infections occurred in this group. The ability to use conventional surgical instruments was advantageous in several cases. CONCLUSIONS: Comparable exposure was achieved in this cohort of patients with gasless laparoscopy. The use of conventional surgical instruments provides an advantage with this technique. Further improvements in abdominal wall lift systems and modification of existing surgical instruments may expand the role of gasless laparoscopy.

Abdominal Injuries↗