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PubMed2002

[Laparoscopic transperitoneal replacement of the abdominal aorta with left renal artery reimplantation: experimental study on pigs].

OBJECTIVE: To study the feasibility and the tolerance of a combined laparoscopic transperitoneal aortic and renal restoration performed on animals. METHODS: Six pigs (mean weight: 79.5 kg, range 73-86) underwent laparoscopic replacement of the abdominal aorta using a 6-mm Dacron(R) graft, with direct reimplantation of the left renal artery. The study protocol was approved by the Advisory committee of Animal Ethics. The animal was placed supine on the operative table with a pillow under the lumbar region in order to raise the aortic area. A first midline, 10-mm diameter trocar was placed under direct vision, 5 cm above the pubis and allowed the insufflation of a 12-mm Hg pneumoperitoneum. One 30 degrees optic was used during the intervention. The pig was then tilted to a 30 degrees Trendelenbourg's position and two other 10-mm trocars were introduced 5 cm medially to the right and left antero-superior iliac spines ). Four other 10-mm incisions were necessary for introduction of an intestinal retractor, a suction-irrigation device and two laparoscopic aortic clamps. RESULTS: The procedure was performed in all animals in a mean operative time of 320 min (292-366), including ): - a time for aortic and renal artery dissection of 104 min (90-120), - a supra-renal aortic clamping time of 221 min (180-276), - a time for confection of proximal and distal aorto-prosthetic anastomosis of respectively 59 min (40-75) and 64 min (50-80), - a time for the left renal artery reimplantation of 72 min (40-140). Average blood loss was 525 ml (250-1050), and the mean pre and postoperative hemoglobin and pH values were 9.9 g/dl (8.9-10.7) versus 9.4 g/dl (8.5-11.3) and 7.36 (7.31-7.38) versus 7.30 (7.21-7.43) respectively. An angiogram ) performed before the sacrifice of animals showed a wide patent anastomosis in 18 (56%) cases, a<50% stenosis in 4 cases (22%), a > 50% stenosis in 1 case (5%) and a thrombosis of the first three renal artery restorations (17%) probably due to insufficient intraoperative heparinization. CONCLUSION: This experimental study shows the feasibility of laparoscopic transperitoneal abdominal aortic restoration with re-implantation of the left renal artery (fig. et ). The techniques of arterial sutures must be improved in order to decrease aortic and renal clamping times.

Anastomosis, Surgical↗
PubMed2006

[A surgical approach to tuberculosis of the thoracic spine and kyphotic deformity and compression of the spinal cord].

In patients with tuberculosis of thoracic vertebrae, kyphotic deformity and compression of the spinal cord involves resection of the involved portion and revision of the vertebral column. Resection was performed with a chisel that has an edge stop. Thus, 2 anterior and 2 posterior incisions (grooves) and a cross bed between them are prepared after resection on adjacent surfaces. The anterior epidural space is revised, by setting the spinal cord free from compressing agents. Three-four posterior rib ends are preliminary crossed above or below the apex of the hump at the level of the ends of transverse processes (desirably on both sides). A spinal deformity-correcting apparatus comprises an anterior loose half and posterior active part. Their bases are fixed on the laths of an operating table at the level of gibbus. The thrust pelots of an anterior tubule are adapted at the level of the presternum and, lower, at the base of the xiphisternum. Active pelots are set paragibbaly. By rotating the holder of the posterior tubule, the vertebral column is pressed down, correcting deformity by 30-40 degrees. A long posterior autograft and an anterior autograft are placed into the prepared incisions, by making spondylodesis and plastic repair of the anterior wall of the vertebral column. Short autografts cut from the posterior rib ends (which becoming superfluous) are tightly inserted between them. The grafts are covered with soft tissues and mediatinal pleura; the ends of the crossed ribs are sown together with transcostal sutures. The operative wound are sown with transcostal and intercostal sutures. A drain is taken through the ninth intercostal space.

Equipment Design↗
PubMed1997

Liver transplantation: review of the literature. Part 3: Medical complications.

The first attempted human orthotopic liver transplantation, in 1963, involved a child with biliary atresia, who died on the operating table as a result of uncontrollable coagulopathy. Improvements in immunosuppression, surgical technique, medical imaging and postoperative care, as well as more stringent patient selection, have allowed the development of liver transplantation and its universal acceptance as the treatment for a variety of liver diseases. The radiologist plays a major role in the multidisciplinary transplantation team and must be familiar with each stage of orthotopic liver transplantation and its associated complications. In the first article of this series (Can Assoc Radiol J 1997;48[3]: 171-178), the authors reviewed the anatomic features and current concepts relevant to orthotopic liver transplantation. In the second article (Can Assoc Radiol J 1997;48[4]: 231-242), they discussed the vascular and biliary complications of the operation. This, the third and final article in the series, covers the medical complications.

Communicable Diseases↗
PubMed1990

Multilevel spine fractures: intraoperative nursing management.

Stabilization of multiple level spine fractures in blunt trauma victims is an extensive and complicated surgical procedure. A multidisciplinary approach to the thoracolumbar anatomy and subsequent stabilization poses a variety of challenges to the neurosurgical operating room staff. Transfer to the operating table and positioning for the procedure are dictated by the following treatment protocol for vertebral fractures: immobilization and stabilization of fractures with skin or skeletal traction, administration of parenteral muscle relaxants and analgesics, assessment and documentation of neurologic status, maintenance of bone and joint alignment and provision of skin care. Standard preoperative preparation and intraoperative nursing diagnoses and interventions are discussed. The importance of communication and psychological support to family members is stressed.

Humans↗
PubMed1977

Detecting complications of direct arterial surgery: the role of intraoperative arteriography.

Intraoperative arteriography was carried out using a specially constructed operating table and long x-ray film changer that permitted rapid serial exposure of the arterial reconstruction and the distal arteries. During a ten-year period, this method was applied in 1,810 arterial reconstructions, with technical problems being detected in 82 (4.6%) of these patients. The incidence of problems was highest in patients undergoing endarterectomy, where 16.7% of the patients were found to have either residual debris in the cleared segment or areas of stenosis. When bypass grafts were used, technical problems were found in 2.2% of patients and included embolism or thrombosis, graft torsion in vein grafts, stenosis of the distal anastomosis, and the creation of an intimal flap. In the entire series, five patients needed reoperation in the early postoperative period. In three of these, the operative arteriograms had been initially misread.

Angiography↗
PubMed2005

Robotic assisted multivessel minimally invasive direct coronary artery bypass with port-access stabilization and cardiac positioning: paving the way for outpatient coronary surgery?

BACKGROUND: Minimimal access multivessel coronary artery bypass grafting with same day hospital discharge remains the ultimate goal. We evaluated the feasibility for achieving multivessel coronary bypass through minimal access. METHODS: From January to July 2003, 30 patients under went off-pump minimally invasive multivessel coronary bypass. Internal mammary arteries were harvested with robotic telemanipulation with three ports. A 2-inch to 3-inch incision with soft tissue retractor was used to perform coronary anastomosis. Robotic ports were used to introduce stabilization and cardiac positioning devices. Endoscopic harvesting of radial artery was done when necessary. RESULTS: Twenty-three patients (77%) had anterior throracotomy approach and 7 (23%) had transabdominal approach. Average number of bypass grafts was 2.6 (range 2-4). There was no mortality in hospital or on 30-day follow-up. Twenty-nine patients (97%) were extubated on the operating table. Two patients required reoperation for bleeding and 1 of those patients needed conversion to sternotomy for additional bypass grafting. Within 24 hours of surgery 50% of patients (n = 15) were discharged, 10% (n = 3) were discharged in 24 to 36 hours, 17% (n = 5) were discharged in 36 to 48 hours, 17% (n = 5) were discharged in 48 to 72 hours, and 2 patients stayed more than 3 days in the hospital. Two patients needed readmission to hospital within 30 days; 1 for pleural effusion and 1 for wound infection. CONCLUSIONS: Robotic harvesting of internal mammary arteries and port access stabilization and cardiac positioning allows multivessel coronary bypass to be performed through a small incision. Currently, the majority of the patients can be safely discharged within 36 hours of operation.

Aged↗
PubMed1994

The dermatologic surgical suite.

In summary the size, layout, surgical lighting, and operative table are the most important variables in providing a comfortable, efficient surgical suite. Each physician will develop their own likes and dislikes when using and experimenting with various instruments and surgical devices. Wherever possible, trial periods should be obtained before committing excessive funds to major purchases. Nothing replaces personal experience in making such selections. A well-equipped, well-designed surgical suite improves the experience for both patients and the dermatologic surgeon.

Dermatology↗
PubMed2003

Preliminary experience in glioma surgery with intraoperative high-field MRI.

OBJECTIVE: To apply a new setup, combining the benefits of high-field magnetic resonance imaging (MRI) with microscope-based neuronavigation, providing anatomical and functional guidance, in glioma surgery. MATERIAL AND METHODS: MR imaging was performed using a 1.5 T scanner, located in a radiofrequency-shielded operating theatre. The patient is lying on a rotating operating table, which is locked at the 160 degree position for surgery at the 5 G zone and turned into the scanner for imaging. The microscope, placed in the 5 G zone, in combination with a ceiling mounted navigation system enables microscope-based neuronavigation; integrated data from magnetoencephalography and functional MRI provide functional guidance. RESULTS: 126 patients were investigated with intraoperative high-field MRI, among them were 37 patients with gliomas. In the biopsy/catheter group (n = 8) MRI reliably depicted the needle position or the location of catheter placement. In the group with glioma resection (n = 29) intraoperative MRI revealed that the surgical objective was not achieved in 28%, leading to further tumour removal. We did not observe complications attributable to intraoperative high-field MRI. Image quality was not diminished by the operating room equipment, so that there was nearly no noticeable difference between pre- and intraoperative image quality. Neuronavigational guidance was applied in 31 patients: the integrated use of functional data prevented an increased morbidity despite extended resections. CONCLUSION: Intraoperative high-field MRI allows a reliable delineation of the extent of resection in glioma surgery. If the surgical objective was not met, a modification of the surgical strategy during the same operation is possible, thus leading to more radical resections. Furthermore, high-field MRI offers increased image quality and a much broader spectrum of different imaging modalities, compared to previous intraoperative low-field systems.

Adolescent↗
PubMed2000

[Working posture of laparoscopy-practicing surgeons: ideal and reality].

Since laparoscopic surgery has been established the advantages for the patients of minimal invasive surgery have been discussed extensively. But this method holds considerable disadvantages, due to the non-ergonomic surgeons working position. This is mainly caused by the false positioning of the monitor and operating table as well by the use of foot switches and differing instrument handles. The common working position of the laparoscopically working surgeon leads to serious risks for the patient. The industry and hospital administrations do not know anything about this and only few surgeons are aware of these dangers. The authors want to draw attention to the insufficiencies of the laparoscopic working place. Due to missing resources until now no general concept has been developed that meets current standards.

Ergonomics↗
PubMed1992

Aseptic technique in microgravity.

Within the next decade, the United States will launch a space station into low Earth orbit as a preliminary step toward a manned mission to Mars. Provision of asepsis in the unique microgravity environment, essential in operative and invasive procedures, is addressed. An assessment of conventional terrestrial aseptic methods and possible modifications for a microgravity environment was done during the microgravity portion of parabolic flight on NASA KC-135 aircraft. During 110 parabolas on three flight days, a "surgical team" (surgeon, scrub nurse and circulating nurse) using a life size mannequin fastened to a prototype surgical "work station" (operating table), evaluated open and closed gloving (ten parabolas), skin preparation (six parabolas), surgical scrub methods (24 parabolas), gowning (22 parabolas) and draping (48 parabolas). Evaluated were povidone iodine solution, 1 percent povidone iodine detergent, Chloroxylenol with detergent, wet prep soap sponge, a water insoluble iodophor polymer (DuraPrep, 3M), disposable towels, disposable and reusable gowns, large and small disposable drapes with and without adhesive edges, disposable latex surgeon's gloves with and without packaging modifications and restraint mechanisms (tether, swiss seat, waist and foot restraint devices, fairfield and wire clamps and clips). Ease of use, provision of restraint for supplies and personnel and waste disposal were assessed. The literature was reviewed and its relevance to the space environment discussed, including risk factors, environmental contamination, immune status and microbiology. The microgravity environment, limited water supply and restricted operating area mandated that modifications of fabrication and packaging of supplies and technique be made to create and preserve asepsis. Material must meet stringent flammability and off-gassing standards. Either a chlorhexidine or povidone iodine detergent prepackaged brush and sponge would provide an adequate scrub plus preliminary cleansing of a dirty wound. Choice may depend on ease of removal from the water supply as well as sensitivity to each compound of individual crew members. Rinsing was achieved with sterile water soaked gauze. Drying would be more efficient with two small hand towels, which would be easier to manipulate in microgravity and require less stowage volume. Skin preparation highlighted unexpected packaging problems, as centrifugal force was required to "shake" the solution out of the container on to the mannequin. To minimize contamination, a gown should be folded in an accordion manner and fastened to the base of its sterile wrapper, so that an assistant can compensate for the lack of gravity by applying constant tension.(ABSTRACT TRUNCATED AT 400 WORDS)

Aerospace Medicine↗
PubMed1999

A mobile high-field magnetic resonance system for neurosurgery.

OBJECT: The authors' goal was to place a mobile, 1.5-tesla magnetic resonance (MR) imaging system into a neurosurgical operating room without adversely affecting established neurosurgical management. The system would help to plan accurate surgical corridors, confirm the accomplishment of operative objectives, and detect acute complications such as hemorrhage or ischemia. METHODS: The authors used an actively shielded 1.5-tesla magnet, together with 15 mtesla/m gradients, MR console computers, gradient amplifiers, a titanium, hydraulic-controlled operating table, and a radiofrequency coil that can be disassembled. The magnet is moved to and from the surgical field by using overhead crane technology. To date, the system has provided unfettered access in 46 neurosurgical patients. In all patients, high-definition T1- and/or T2-weighted images were rapidly and reproducibly acquired at various stages of the surgical procedures. Eleven patients underwent craniotomy that was optimized after preincision imaging. In four patients who harbored subtotally resected tumor, intraoperative MR imaging aided the surgeon in removing the remaining tumor. Interestingly, the intraoperative administration of gadolinium demonstrated a dynamic expansion of enhancement beyond the preoperative contrast contour in patients with malignant glioma. These zones of new enhancement proved, on examination of biopsy samples, to be tumor. CONCLUSIONS: The authors have demonstrated that high-quality MR images can be obtained in the operating room within reasonable time constraints. Procedures can be conducted without compromising or altering traditional neurosurgical, nursing, or anesthetic techniques. It is feasible that within the next decade intraoperative MR imaging may become the standard of care in neurosurgery.

Adult↗
PubMed2004

Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience.

BACKGROUND: In the last few years, robotics has been applied in clinical practice for a variety of laparoscopic procedures. This study reports our preliminary experience using robotics in the field of general surgery to evaluate the advantages and limitations of robot-assisted laparoscopy. METHODS: Thirty-two consecutive patients were scheduled to undergo robot-assisted laparoscopic surgery in our units from March 2002 to July 2003. The indications were cholecystectomy, 20 patients; right adrenalectomy, two points; bilateral varicocelectomy, two points; Heller's cardiomyotomy, two points; Nissen's fundoplication, two points; total splenectomy, one point; right colectomy, one point; left colectomy, 1 point; and bilateral inguinal hernia repair, one point. In all cases, we used the da Vinci surgical system, with the surgeon at the robotic work station and an assistant by the operating table. RESULTS: Twenty-nine of 32 procedures (90.6%) were completed robotically, whereas three were converted to laparoscopic surgery. Conversion to laparoscopy was due in two patients to minor bleeding that could not be managed robotically and to robot malfunction in the third patient. There were no deaths. Median hospital stay was 2.2 days (range, 2-8). CONCLUSIONS: The main advantages of robot-assisted laparoscopic surgery are the availability of three-dimensional vision and easier instrument manipulation than can be obtain with standard laparoscopy. The learning curve to master the robot was >or= 10 robotic procedures. The main limitations are the large diameter of the instruments (8 mm) and the limited number of robotic arms (maximum, three). We consider these technical shortcomings to be the cause for our conversions, because it is difficult to manage bleeding episodes with only two operating instruments. The benefit to the patient must be evaluated carefully and proven before this technology can become widely accepted in general surgery.

Adult↗
PubMed2000

Intestinal retractor for transperitoneal laparoscopic aortoiliac reconstruction: experimental study on human cadavers and initial clinical experience.

BACKGROUND: We set out to design a bowel retractor for use during laparoscopic transperitoneal reconstruction of the infrarenal aorta and of both iliac axes. METHODS: This study was performed on five cadavers. After the insertion of four trocars, a pneumoperitoneum was created, and the bowels were gathered to the right flank. On each cadaver, the following four measurements were made: the distance between the Treitz angle and the aortic bifurcation (L1), the distance between the aortic bifurcation and the right internal inguinal ring (L2), the angles between L1 and L2 in the axial plane (A1), and the angles between them in the sagittal (A2) plane. These measurements enabled us to create a bowel retractor. The device was composed of a malleable metallic rod with a 2.5-mm diameter that was fixed to the operating table and whose intraabdominal section was designed to follow the outline of the mesenteric root in addition, a 25 x 12 cm polypropylene net was slipped around the rod. The infrarenal aorta and both iliac axes were then dissected. Secondarily, the bowel retractor was used in eight patients (seven men and one woman; mean age, 56 years; range 44-76) during laparoscopic aortoiliac reconstruction for occlusive (n = 6) or aneurysmal (n = 2) disease. RESULTS: The statistical analysis of the measurements performed on cadavers showed a significant correlation between body height and L1 (r = 0.8769; p < 0.05) and L2 (r = 0. 9706; p < 0.01) distances. It was then possible to design the shape of two metallic rods (one small and one large) so that they would be adaptable to the height of the patients (<1.65 m and >1.65 m). During our clinical experience, all laparoscopic procedures were completed in a mean operative and clamping time of 266 min (range, 215-360) and 54 min (range, 18-90), respectively. Mean postoperative hospital stay was 6 days (range, 3-13). CONCLUSION: Our experimental study allowed us to develop a bowel retractor that can make it easier to perform laparoscopic transperitoneal aortoiliac reconstruction in humans.

Adult↗
PubMed1989

[Translumbar radical nephrectomy of renal cell carcinoma].

We invented a new surgical approach to the kidney through the flank to perform a radical nephrectomy for renal cell carcinoma. With the patient in usual lateral decubitus position keeping the dorsum vertical to the operating table, a skin incision is made over the XII rib from the posterior axillary line to the lateral edge of the rectus muscle. After the tip of XII rib is resected by about 5 cm, the retroperitoneal space is entered. Blunt dissection of the posterior aspect of Gerota's fascia from fasciae of the quadratus lumborum and psoas muscle is easily carried out with a liver retractor or intestinal spatula. The pulsating renal artery can be identified through Gerota's fascia when the renal hilus is exposed. Following ligation and division of the artery, renal vein is exposed. On the left side, adrenal, gonadal and occasionally lumbar veins are also ligated and severed in addition to the renal vein. Then, the kidney in Gerota's fascia is removed en bloc with perinephric adipose tissue and adrenal gland. Of 21 patients with renal cell carcinoma seen during 1 year and 3 months from June 1987, 11 underwent this operation, and other 10 patients transperitoneal radical nephrectomy because of the possible tumor extension into the renal vein, inferior vena cava or adjacent organ, the severe spinal deformity or metastases and the necessity of additional surgical procedures for concomitant benign intraperitoneal diseases. The blood loss was smaller and operating time was shorter significantly in the translumbar group than the evaluable transperitoneal group. None of those in the translumbar group received blood transfusion. As complications, pneumothorax due to pleural injury during operation and postoperative incisional hernia occurred each in one patient, but no other serious one was found. From the above results, this approach seems to be one of choices for the surgical treatment of renal cell carcinoma, as long as the tumor is not likely to extend to adjacent organs, ipsilateral nodes or the inferior vena cava.

Adult↗
PubMed1999

[How to avoid injuries in connection with surgery? Perioperative nerve injuries are probably underreported].

The occurrence of mechanical nerve injury in connection with anaesthesia and surgery is probably more common than generally believed, and by no means all cases are reported to the patient injury claims department. Both incorrect positioning of the patient on the operating table and pressure from retractors and other instruments can contribute to the occurrence of such injuries. Both neurological and neurophysiological procedures should be used to localise the injury, particularly for the purpose of insurance assessment. Most important of all, however, is prevention of injury. Risk minimisation is dependent on the observation of meticulous routines in surgery units, and clear division of staff responsibilities. The surgical injury rate can be monitored by means of a register of general complications.

Humans↗
PubMed2005

Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases.

BACKGROUND: Previous studies show that local recurrences after breast-conserving treatment occur in the site of the primary tumor. The need for postoperative radiotherapy on the whole breast is challenged in favor of radiotherapy limited to the area of the breast at high risk of recurrence. The new mobile linear accelerators easily moved close to the operating table to allow the full-dose irradiation during surgery. PATIENTS AND METHODS: From July 1999 to December 2003, 590 patients affected by unifocal breast carcinoma up to a diameter of 2.5 cm received wide resection of the breast followed by intraoperative radiotherapy with electrons (ELIOT). Most patients received 21 Gy intraoperatively, biologically equivalent to 58 to 60 Gy in standard fractionation. Patients were evaluated 1, 3, 6, and 12 months after surgery, and thereafter every 6 months, to look for early, intermediate, late complications, and other events. RESULTS: After a follow-up from 4 to 57 months (mean, 24 months; median, 20 months), 19 patients (3.2%) developed breast fibrosis, mild in 18, severe in 1, which resolved within 24 months. Three patients (0.5%) developed local recurrences, 3 patients ipsilateral carcinomas in other quadrants and other 5 patients contralateral breast carcinoma. One patient (0.2%) died of distant metastases. CONCLUSIONS: ELIOT is a safe method for treating conservatively operated breasts, avoids the long period of postoperative radiotherapy, and reduces drastically the cost of radiotherapy. ELIOT reduces radiation to normal tissues and organs. Results on short-term and middle-term toxicity up to 5 years of follow-up are good. Data on local control are encouraging.

Adenocarcinoma↗
PubMed2000

The clinical performance of a small diameter tibial nailing system with a mechanical distal aiming device.

We present the clinical and radiographic results of a prospective study with the Orthofix tibial nailing system. The ease and safety of distal locking with the use of an improved targeting system was also evaluated. Sixty fresh tibial fractures in 60 patients with a mean age of 37.3 years (range 17-73 years) were treated. Eighteen of the fractures were grade I open fractures. All operations were performed in a conventional operating theatre on a simple transparent operating table, with reduction of the fracture performed under manual traction and manipulation of the fracture site. Hand reaming was then performed to ensure, where possible, the insertion of a nail of at least 9 mm in diameter. Fracture healing was observed at a mean of 17 weeks (12-28 weeks). No tibial non-unions occurred in our series, and only three fractures, two segmental and one severely comminuted, showed delayed union. No infection, either superficial or deep, was found and no cardio-pulmonary complications were recorded. Following surgery, all patients gained a full range of pain-free movement of the ankle and knee joints and only six patients (10%) complained of mild anterior knee pain. All patients returned to their previous jobs one month after fracture healing had been confirmed clinically and radiographically. Following nailing, no deviation from normal tibial alignment was detected. No mechanical failure of either the nails or the locking screws was recorded. The mean duration of operation (skin to skin) was 30 min (range 20-45 min) and the mean total theatre time was 55 min (range 40-75 min). The mean total intensification time was 5 s. In total, 120 distal locking screws were inserted using the external targeting device. All attempts at distal locking except five (4.2%) were successful with two failures in the same patient being a result of inappropriate use of the system. We conclude that this nailing system is clinically effective and that distal locking can be performed easily, without exposure to radiation.

Adolescent↗
PubMed2001

Radiation exposure with use of the inverted-c-arm technique in upper-extremity surgery.

BACKGROUND: Intraoperative fluoroscopy is commonly used in surgical procedures on upper extremities. We compared radiation exposure from two possible positions of the mobile digital fluoroscopy unit (c-arm): (1) the standard technique, with the x-ray tube down (near the floor) and the image intensifier at the top of the c-arm, and (2) the inverted position, in which the image intensifier is used as a table and the x-ray tube is up. METHODS: A commercially available c-arm was used to irradiate a phantom hand in one of three configurations. In the first, the phantom hand was placed on an armboard equidistant from the x-ray tube and the image intensifier with the beam directed upward. In the second, the c-arm was inverted with the beam directed downward and the image intensifier used as a table. The third configuration was identical to the second except that a magnified image was used. Radiation exposure was measured at four locations corresponding to the approximate position of the surgeon's head, chest, and groin and the patient's hand. RESULTS: The amount of radiation exposure to both the surgeon and the patient was significantly less when the c-arm was used in the inverted position (p < 0.0001). The dose rate to the patient's hand was reduced by 59%. The radiation exposure to the surgeon's head, body, and groin with the inverted-c-arm technique was 67%, 45%, and 15% of the measured doses with the x-ray-tube-down configuration. When we used the magnification mode of the image intensifier, with its correspondingly smaller field size, the doses were further reduced to 46%, 32%, and 11% of the standard-configuration values. CONCLUSIONS: Use of the inverted-c-arm technique with the image intensifier as an operating table can significantly reduce radiation exposure to the surgeon and the patient during surgical procedures on upper extremities.

Arm↗