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At least 595 records · Page 33Linked to original sources
PubMed2005

Positive effect of posterior instrumentation after surgical posterior decompression for extensive cervicothoracic ossification of the posterior longitudinal ligament.

STUDY DESIGN: A case report of a 55-year-old patient with extensive cervicothoracic ossification of the posterior longitudinal ligament (OPLL) that was treated with posterior decompression and fusion. OBJECTIVE: To report the preventive effect of posterior instrumentation on postoperative paralysis in extensive cervicothoracic OPLL. SUMMARY OF BACKGROUND DATA: Thoracic myelopathy caused by OPLL in the thoracic spine was treated with operative decompression of the spinal cord via an anterior, posterior, or posterolateral approach. However, the lack of availability for some approaches in specific cases, as well as reports of some problems for each approach, indicates that a lack of consensus still remains regarding the choice of operative procedure. METHODS: A 55-year-old female with extensive cervicothoracic OPLL presented with progressive numbness in the both hands and a gate disturbance. Cervical laminoplasty, thoracic laminectomy, and posterior fusion were performed with electrophysiologic monitoring of the spinal cord evoked potential. RESULTS: After thoracic laminectomy, the amplitude of spinal cord evoked potential waveforms decreased but recovered after a posterior fusion by instrumentation. CONCLUSION: Prevention of postoperative paralysis from increasing by posterior instrumentation was shown using neurophysiologic monitoring.

Cervical Vertebrae↗
PubMed1993

Architecture and functional design of advanced neurosurgical operating environments.

Although modern operative neurosurgery is a complex technical undertaking requiring an amalgam of technologies and instrumentations, few reported efforts have dealt with the definition and development of suitable and optimal dedicated operating environments. This report presents the first detailed description of a dedicated, self-contained neurosurgical operating suite incorporating major surgical instrumentation and visualization technologies to provide an "idealized" environment for stereotactic, microscopic, and microstereotactic procedures. Advanced computer technology for visualization to augment, simulate, document, and facilitate all aspects of neurosurgery is described. The architectural and functional design of the operating suite is itself an integral surgical instrument as well as a laboratory for development of new dimensions of neurosurgery.

Computer Systems↗
PubMed1987

Stereotactic computer graphic system with brain maps.

We have developed a stereotactic computer graphic system with brain maps that runs on a personal computer. This system consists of three parts: 1. firmware for dizitizing radiological films with a TV camera or scanner (when digital image is not directly obtained from floppy disks); 2. software for introducing or processing brain maps by matching them with CT or NMR images; 3. hardware. Our system is designed to: 1. recognize the relevant frame points and calculate targets, their volume and surgical instrument trajectory; 2. match between brain maps of an ideal brain and patient's CT or NMR images with visible and invisible pathology; 3. monitor during surgery the position of the surgical instrument or target modification. The whole procedure and processed images are stored in a data-base for further study.

Brain Mapping↗
PubMed1998

Adaptive canceling of physiological tremor for improved precision in microsurgery.

Physiological hand tremor impedes microsurgery. We present both a novel adaptive algorithm for tremor estimation and a new technique for active real-time canceling of physiological tremor. Tremor is modeled online using the weighted-frequency Fourier linear combiner (WFLC). This adaptive algorithm models tremor as a modulating sinusoid, and tracks its frequency, amplitude, and phase. Piezoelectric actuators move the surgical instrument tip in opposition to the motion of tremor, effectively subtracting the tremor from the total motion. We demonstrate the technique in one dimension using a cantilever apparatus as a benchtop simulation of the surgical instrument. Actual hand motion, prerecorded during simulated surgery, is used as input. In 25 tests, WFLC tremor compensation reduces the rms tip motion in the 6-16 Hz tremor band by 67%, and reduces the rms error with respect to an a posteriori estimate of voluntary motion by 30%. The technique can be implemented in a hand-held microsurgical instrument.

Algorithms↗
PubMed2003

Precision and safety of the pulsed electron avalanche knife in vitreoretinal surgery.

BACKGROUND: We have developed a new surgical instrument, called the pulsed electron avalanche knife (PEAK; Carl Zeiss Meditec, Jena, Germany), for precise, "cold," and tractionless dissection of tissue in liquid media. OBJECTIVE: To evaluate the 3-dimensional damage zone induced by the PEAK compared with 2 other standard intraocular surgical instruments, diathermy and retinal scissors. METHODS: Damage zone and minimum safe distance were measured in vitro on chick chorioallantoic membrane and in vivo on rabbit retina with the use of propidium iodide staining. RESULTS: The PEAK produced a paracentral zone of cellular structure disruption surrounding a crater and a peripheral zone of structurally intact but abnormally permeable cells. The instrument induced a damage radius that varied from 55 to 300 micro m for the range of voltages and pulses typically used during surgery. For comparison, damage radius for microsurgical scissors was 50 micro m, and for diathermy, 400 to 850 micro m. The PEAK also damaged tissue up to 1.4 mm away by the creation of water flow that formed at the tip of convex probes during collapse of a cavitation bubble. Concave probes, which prevent formation of the water jet, eliminated this effect. CONCLUSIONS: The PEAK operated well within accept-able safety limits and may greatly facilitate both posterior segment surgeries (eg, membrane dissection and sheathotomy) and anterior segment procedures (eg, capsulotomy, nonpenetrating trabeculectomy, and iridectomy).

Allantois↗
PubMed1989

[Sterilization and quality control].

The dental profession has always considered the sterilization of surgical instruments as an important element in the prevention of infection. During the last decade the concern with blood and to a lesser degree with saliva in the transmission of infection, due primarily to the hepatitis and HIV viruses, has resulted in many corporate organizations releasing recommendations to reinforce the use of sterilization techniques and disinfection techniques when sterilization is not applicable or justifiable. As a result of the fact that the two terms are often intermingled, the authors review the fact that each one pursues different objectives and put the emphasis on sterilization by briefly reviewing the principal advantages and disadvantages of each method of sterilization presently available for use in dental offices. Subsequently, they stress the importance of introducing quality control in any infection prevention program, in order to assure that the sterilization process is not at the mercy of human error or mechanical failure. The pharmaceutical industry, food chains and hospital centres have for more than 40 years realized the importance of using chemical indicators and especially biological testing. Only biological testing can put one's mind at ease, for the professional in a dental office and the patient receiving care, that the instruments or objects that one comes in contact with are truly sterile. The dental profession did not wait for the discovery of the hepatitis B and HIV viruses to become preoccupied with the spread of disease and have sterilized their surgical instruments for many years.(ABSTRACT TRUNCATED AT 250 WORDS)

Communicable Disease Control↗
PubMed1997

Virtual reality in endonasal surgery.

Virtual environments provide a new dimension of graphic simulation. The interaction between the human and the computer is now intuitive for the user. The use of virtual reality (VR) gives the user the feeling of participating in a (computer generated) scenario very much like reality. This feeling is an essential requirement for simulation of surgical interventions using digital data. Especially in the fields of sinus and skull-base surgery, computer assisted simulation could present a valuable and effective alternative method for honing endoscopic skills. Traditionally, surgeons gain experience through anatomic preparation and education by more experienced colleagues. Landmarks like skull base, carotid arteria or optical nerve have to be identified intraoperatively in order to orientate in this critical region. Highly sensitive structures can be damaged most easily. The quality of surgical skills can be characterized as the sum of knowledge, individual experience and manual dexterity. It is conceivable that a surgeon's level of training and experience could be significantly increased by use of VR. With this in mind, a VR-based simulator for procedures in sinus surgery will improve most of these parts. To provide the virtual environment, a realistic representation of the region of interest with all relevant anatomical structures is required. Based on data from tomographic imaging studies, a three-dimensional representation of the paranasal sinuses is semiautomatically reconstructed. Textures derived from endoscopic images are superimposed on the virtual anatomic structures and provide better realism. Two main components of the VR interface can be distinguished: the 3-D interaction to guide the surgical instruments and the 2-D graphical user interface for visual feedback and control of the session. Moreover, the 3-D interaction has to be realized by means of Virtual Reality techniques providing a simulation of an endoscope and an intuitive handling of other surgical instruments.

Computer Simulation↗
PubMed1998

The virtual reality arthroscopy training simulator.

Arthroscopy has already become an irreplaceable method in diagnostics. The arthroscope, with optics and light source, and the exploratory probe are inserted into the knee joint through two small incisions underneath the patella. Currently, the skills required for arthroscopy are taught through hands-on clinical experience. As arthroscopies became a more common procedure even in smaller hospitals, it became obvious that special training was necessary to guarantee qualification of the surgeons. On-the-job training proved to be insufficient. Therefore, research groups from the Berufsgenossenschaftliche Unfallklinik Frankfurt am Main approached the Fraunhofer Institute for Computer Graphics to develop a training system for arthroscopy based on virtual reality (VR) techniques. Two main issues are addressed: the three-dimensional (3-D) reconstruction process and the 3-D interaction. To provide the virtual environment a realistic representation of the region of interest with all relevant anatomical structures is required. Based on a magnetic resonance image sequence a realistic representation of the knee joint was obtained suitable for computer simulation. Two main components of the VR interface can be distinguished: the 3-D interaction to guide the surgical instruments and the 2-D graphical user interface for visual feedback and control of the session. Moreover, the 3-D interaction has to be realized by means of Virtual Reality techniques providing a simulation of an arthroscope and an intuitive handling of other surgical instruments. Currently, the main drawback of the developed simulator is the missing of haptic perception, especially of force feedback. In cooperation with the Department of Electro-Mechanical Construction at the Technical University Darmstadt a haptic display is designed and built for the VR arthroscopy training simulator. In parallel we developed a concept for the integration of the haptic display in a configurable way.

Arthroscopy↗
PubMed1979

Intestinal anastomoses after radiation therapy by surgical stapling instruments.

The use of automated stapling instruments in 17 patients requiring intestinal surgery following irradiation therapy for gynecologic malignancies has been reviewed. Fifteen of these patients also had other medical problems thought to inhibit optimal anastomotic healing: malnutrition, persistent intraabdominal cancer, uremia, hypoalbuminemia, and recent antineoplastic chemotherapy. Although these conditions severely test a method of intestinal anastomosis, no patient had a complication involving the intestinal anastomosis. The use of these stapling instruments reduced both the operating time and the contamination of the peritoneal surfaces by bowel content, thereby improving the postoperative recovery of these patients. The favorable results and the secure anastomoses justify the continued use of stapling instruments in gynecologic oncology patients with prior irradiation therapy.

Female↗
PubMed2001

Telepresence surgery: first experiences with laparoscopic radical prostatectomy.

The concept of an intelligent steerable surgical instrument system has been described by various authors. Since 1998, telesurgical minimally invasive procedures have been performed with the da Vinci system, mainly for cardiac bypass surgery. We present our initial experience using the device for robot-assisted laparoscopic radical prostatectomy. The intuitive surgical system consists of two main components: the surgeon's viewing and control console with 3D-imaging, and the surgical arm unit that positions and manoeuvres detachable surgical instruments. These instruments are introduced via two 8 mm trocars and allow movements in all six degrees of freedom (DoF). The surgeon performs the procedure while seated at the console holding specially designed instruments. Highly specialised computer software and mechanics transmit the surgeon's hand movements exactly to the microsurgical movements of the manipulators at the operative site. The system used is a W-shaped five trocar arrangement, with the robot's arms at the lateral trocars (8 mm) and two assistant trocars medially (10 mm). A sixth trocar was used in the right suprapubic area for retraction of the gland (Foley catheter). The left assistant used different instruments, such as bipolar forceps, Ultracision, and Endoclip, wheras the right assistant mainly used the suction–irrigation device. The Intuitive System was attached after trocar placement and exposure of Retzius' space. We treated six patients (two pT2, four pT3, median Gleason score 6). The operating room time averaged 315 (range 242–480) min, including pelvic lymph-node dissection. No intra-operative complications occured, one patient required transfusions. There were no positive margins, median catheter time was 5 days. Three patients were completely continent after 1 month. Telerobotic laparoscopic radical prostatectomy is feasible. There is a learning curve with the device, mainly due to the magnification, 3D image and lack of tactile feedback. However, the experienced surgeon can become familiar with the device after a short time. There is still a need for further development of instruments for urological procedures.

Journal Article↗
PubMed1999

ARTEMIS. A telemanipulator for cardiac surgery.

ARTEMIS, the Advanced Robotics and TElemanipulator System for Minimally Invasive Surgery, is designed as an integrated teleoperation and telepresence system for planning, training and performing different minimally invasive surgical procedures. The actual prototype was developed as an experimental device for exploring and testing the needed technologies and their capability and quality with respect to surgical application. The main components are two master-slave units guiding the surgical instruments and a remotely controlled endoscope guiding system. Each master-slave device consists of the slave or work unit and the master or control unit which are interconnected by a computer based control system. The work unit is operating at the patient by means of dexterous surgical instruments consisting of multifunctional endoeffectors with flexible distal section providing six degrees of freedom. The kinematic structure of the work unit ensures a precise motion around the incision point through the abdominal or thoracic wall. The master or control unit guided by the surgeon is designed to enable the surgeon to operate intuitively as if he were guiding the tip of the endoeffector manually. The powered endoscope guiding system is equipped with a 3D-endoscope. The computer based control system interconnecting control and work units has an open system architecture which allows to couple differently designed masters and slaves, monitoring systems, graphical system and user interfaces. The endoscope can be guided by a simple joystick, voice control or automatic camera tracking. For minimally invasive cardiac surgery a new concept has to be developed. In co-operation with the Cardiovascular Institute of the University of Dresden a step-by-step procedure was agreed. The state-of-the-art is described.

Cardiac Surgical Procedures↗
PubMed2001

Spinal lordosis with marked opisthotonus secondary to dystonia musculorum deformans: case report with surgical management.

STUDY DESIGN: A case report of severe spinal lordosis with marked opisthotonus and retrocollis secondary to dystonia musculorum deformans is presented. OBJECTIVE: To describe a case of dystonia musculorum deformans with progressive spinal lordosis and its surgical treatment. SUMMARY OF BACKGROUND DATA: Four patients with correction of coronal spinal deformity associated with dystonia musculorum deformans have been reported in the literature. No reports of sagittal spinal deformity treated with surgical instrumentation and fusion were found. METHODS: A retrospective chart and radiographic review of a single case was conducted. RESULTS: Orthotic management and pharmacologic therapy with botulinum toxin injections were unsuccessful in controlling the deformity. Severe spinal lordosis (170 degrees ) from occiput to sacrum was corrected surgically, allowing an upright posture. CONCLUSION: Dystonia musculorum deformans is a rare condition resulting in coronal or sagittal plane deformities. When other treatment methods are unsuccessful, surgical instrumentation and arthrodesis may correct the deformity and improve function.

Adolescent↗
PubMed2005

Totally endoscopic robotic-assisted repair of patent ductus arteriosus and vascular ring in children.

BACKGROUND: This study reports on our initial experience with robotically assisted patent ductus arteriosus (PDA) closure and vascular ring division in children. METHODS: From April 2002 to May 2004, 15 patients underwent PDA closure (n = 9) and vascular ring repair (n = 6) by a totally endoscopic approach, utilizing the Da Vinci robotic system. The mean age of the patients was 8.3 +/- 4.7 years (range, 3 to 18) and the mean weight, 35.5 +/- 19.0 kg (range, 14.1 to 77.0 kg). Three thoracoscopic trocars were used to accommodate the endoscopic camera and two surgical instruments with an additional small incision for lung retraction. After dissection by the surgeon seated at the master console, PDA ligation with clips or division of the atretic arch and ductal ligament was performed. RESULTS: Total operative times were 170 +/- 46 minutes (PDA) and 167 +/- 48 minutes (vascular ring). One patient with vascular ring was converted to thoracotomy because of dense adhesions due to previous surgery. Precise and easy surgical maneuver was possible with the articulated surgical instruments and three-dimensional visualization in 14 patients. Intraoperative transesophageal echocardiography confirmed no persistent shunt in all PDA patients. No laryngeal nerve injury and hemorrhage were noted. All patients were extubated in the operating room. Median length of postoperative hospital stay was 1.5 days. CONCLUSIONS: Robotically assisted PDA closure and vascular ring division is a feasible and safe procedure. Future technologic improvement, including smaller instrument size and incorporation of tactile feedback, may permit application of this technique to even younger infants and intracardiac repairs.

Adolescent↗
PubMed1996

[Computer-assisted surgery of the paranasal sinuses with an opto-electronic stereotaxic system].

BACKGROUND: A basic problem common to all systems for computer-assisted surgery (CAS) is the exact registration and referencing, that is, the transfer of preoperative image data to the intraoperative pathology. A system for computer-assisted ENT surgery should provide high precision as well as noninvasive registration and referencing. We present a system designed for such use in paranasal sinus surgery that is based on optical digitizing with several custom-made self-localizing surgical instruments. METHODS AND RESULTS: The system tracks the correct alignment of the head during CT data acquisition and continuously throughout surgery. A transformation matrix and a plane equation of the CT scan are used to match points of the object space to the image space detecting fiducial markers on the CT scans by an automatic algorithm. For position measurements a special reference frame and surgical instruments were developed and equipped with infrared light-emitting diodes that could be detected in real time. Measurements for repositioning of the reference system in a model and during real operations demonstrated a mean error ranging from 0.69 to 1.01 mm and from 0.76 to 1.67 mm respectively. Clinical experience with the application of the system for 15 patients who underwent surgery for different paranasal sinus pathologies is reported. CONCLUSIONS: Results suggest that the non-invasive reference system and the locatable surgical tools may be effective, accurate and useful for computer-assisted identification of intranasal structures. Such systems may contribute to further improvement of minimal invasive intranasal sinus surgery.

Equipment Design↗
PubMed1999

Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy.

OBJECTIVE: To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. SUMMARY BACKGROUND DATA: Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. METHODS: Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher's exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. RESULTS: One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. CONCLUSIONS: Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased morbidity and mortality rates in patients undergoing pancreaticoduodenectomy. This suggests that preoperative biliary drainage should be avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. Such a change in current preoperative management may improve patient outcome after pancreaticoduodenectomy.

Adolescent↗
PubMed1982

New instrument for rapid hemostasis and division of small vessels.

A new, finely machined surgical instrument is now available for use in placing two hemostatic metal clips at the same time. The instrument eliminates the need for reloading and handling of a second instrument by the surgeon. This instrument, a new version of the classic, clinically proven Weck Hemoclip clips, should revolutionize the technique of ligation and division of small, fragile blood vessels.

Constriction↗
PubMed1997

[Emergency surgery making use of video-assisted thoracoscopy--2 case reports].

We recently experienced two emergency operating cases using video-assisted thoracoscopy. First case was a 17-year-old male with foreign body and pneumothorax in the right thorax. He was emergencilly treated by means of video-assisted thoracoscopic surgery. The operation was carried out using double-lumen endotracheal anesthesia. Short trocars were inserted through the right intercostal spaces to introduce a flexible video thoracoscope and surgical instruments. Foreign body was looked for easily and removed out. Second case was a 22-year-old male with hemo-pneumothorax at the right side. He was treated using video-assisted thoracoscopy emergencilly. Bleeding point was searched and hemostasis was done by the electrical mess and the clip. Bulla was removed out with surgical instruments. These were good adaptation of emergency operation using video-assisted thoracoscope. The advantages of this thoracoscopic surgery are: less operative invasion and postoperative pain, early recovery and short hospital stay, and cosmetic preservation.

Adolescent↗
PubMed1978

Experience with auto suture surgical stapling instruments. Fate of enterically applied staples.

Inverting serosa-to serosa staple applications may lead to intraluminal extrusion of staples. The possible clinical pathological consequences of such a migration are examined. Technical maneuvers designed to prevent errors and expedite safer handling of automatic stapling devices are presented. Automatic stapling instruments, both in the animal model and in the clinical situation, have produced eminently satisfactory results for us.

Animals↗