SEARCH · Search PubMed

Results for “Surgical Instruments”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources

PubMed1996

Instrumentation and techniques for carbon dioxide lasers in equine general surgery.

The carbon dioxide laser has become an important surgical instrument in human and veterinary medicine. The unique properties of this laser make it the instrument of choice for precise incision, coagulation, and vaporization of tissue at the body surface with minimal morbidity to the patient. This article describes the instrumentation and techniques used to perform a variety of equine general surgical procedures with the carbon dioxide laser. The benefits of surgery using the carbon dioxide laser include precise dissection with minimal trauma to adjacent tissues, good hemostasis, and the ability of the laser beam's thermal properties to kill bacteria or tumor cells in the operative field.

Animals↗

PubMed1995

Reduced in vivo local recurrence with contact neodymium: Yttrium-Aluminium-Garnet (Nd:YAG) laser scalpels.

BACKGROUND AND OBJECTIVE: Local recurrence after surgical resection for breast cancer is a significant problem and is often not controlled by radiation or chemotherapy treatments. Local recurrence is thought to be, at least in part, due to residual disease, and/or due to the contamination of the surgical field during resection. STUDY DESIGN MATERIALS AND METHODS: To address this later concern, we defined a model system using the mouse mammary cell line, EMT6. Using this model system, we have directly compared the rate of local recurrence of two different surgical approaches. One approach employed the use of traditional surgical instruments, and the other used a comparatively new contact Nd:YAG laser system. Tumor-bearing animals (242) were randomized into three groups. One group consisted of 50 animals that were not treated; 103 animals were randomized into a treatment group that received surgical resection using traditional instruments; 89 animals were resected using the contact laser system. In both surgical procedures, an intentional incision was made through the tumor and then through an uninvolved portion of the surgical field in an attempt to "seed" the incision using the contaminated surgical instrument. RESULTS: Twenty-one of the 103 scalpel-treated animals had local recurrence; only seven of the 89 laser-treated animal had local recurrence. The untreated group died of disease within 8 weeks. In the treatment groups, recurrences were palpable within 1 week. At the time of death for all groups, no metastatic lesions were noted. CONCLUSION: These findings support the conclusions that the EMT6 cell line is a useful model to study local recurrence and that contact laser surgery provides about a 50% improvement in the control of local disease in vivo (P < 0.05).

Aluminum Silicates↗

PubMed1997

The first twelve cases of computer assisted periacetabular osteotomy.

Image guided freehand navigation of surgical instruments has been applied to the Bernese periacetabular osteotomy, a complex surgical technique for the treatment of dysplastic hips. This navigation system has been introduced into the operating room and has so far been used for 12 patients. Image data from computed tomography (CT) scans are presented in various ways to support the preoperative plan and to provide optimized control of surgical action. Special attention has been paid to the implementation of a sophisticated surgeon-machine interface. This paper describes the features of this novel surgical navigation system and its introduction into the clinical environment.

Acetabulum↗

PubMed2004

Designing optically tracked instruments for image-guided surgery.

Most image-guided surgery (IGS) systems track the positions of surgical instruments in the physical space occupied by the patient. This task is commonly performed using an optical tracking system that determines the positions of fiducial markers such as infrared-emitting diodes or retroreflective spheres that are attached to the instrument. Instrument tracking error is an important component of the overall IGS system error. This paper is concerned with the effect of fiducial marker configuration (number and spatial distribution) on tip position tracking error. Statistically expected tip position tracking error is calculated by applying results from the point-based registration error theory developed by Fitzpatrick et al. Tracking error depends not only on the error in localizing the fiducials, which is the error value generally provided by manufacturers of optical tracking systems, but also on the number and spatial distribution of the tracking fiducials and the position of the instrument tip relative to the fiducials. The theory is extended in two ways. First, a formula is derived for the special case in which the fiducials and the tip are collinear. Second, the theory is extended for the case in which there is a composition of transformations, as is the situation for tracking an instrument relative to a coordinate reference frame (i.e., a set of fiducials attached to the patient). The derivation reveals that the previous theory may be applied independently to the two transformations; the resulting independent components of tracking error add in quadrature to give the overall tracking error. The theoretical results are verified with numerical simulations and experimental measurements. The results in this paper may be useful for the design of optically tracked instruments for image-guided surgery; this is illustrated with several examples.

Computer-Aided Design↗

PubMed1996

Does intraoperative blood loss affect antibiotic serum and tissue concentrations?

OBJECTIVE: To determine the effect of intraoperative blood loss on prophylactic cefazolin and gentamicin serum and tissue concentrations. DESIGN: A prospective study of elective spinal instrumentation surgical procedures with an expected large blood loss. SETTING: Tertiary care, inner-city university hospital. PATIENTS: Eleven adult patients who underwent an elective surgical procedure that involved spinal instrumentation. INTERVENTION: Standard perioperative administration of a combination of cefazolin and gentamicin. Serum and tissue samples were obtained consecutively throughout the surgical procedure. MAIN OUTCOME MEASURES: The effect of intraoperative blood loss on serum and tissue cefazolin and gentamicin concentrations and their pharmacokinetics. RESULTS: At the time of the incision, serum cefazolin concentrations were greater than tissue concentrations (P = .07). A mean dose of 1.8-mg/kg gentamicin yielded low or nontherapeutic serum and tissue gentamicin concentrations. Cefazolin and gentamicin were eliminated from the tissue compartment slower than from the serum compartment (P < .03), while the half-life of cefazolin was significantly (P = .06) longer in the tissue compartment. The volume of distribution of cefazolin was normal (ie, 12.5 L), while the volume of distribution of gentamicin was 5-fold greater than expected. At 60 minutes after the incision, blood loss correlated with cefazolin tissue concentrations (r = -0.66, P = .05). Blood loss correlated with the change in tissue antibiotic concentrations for cefazolin (r = 0.73, P = .04). In addition, the clearance of gentamicin from the tissues correlated with blood loss (r = 0.82, P = .01). CONCLUSIONS: Based on measured pharmacokinetic values, additional doses of cefazolin should be administered when the operation exceeds 3 hours and blood loss is greater than 1500 mL. Doses of gentamicin greater than 1.8 mg/kg should be administered more than 30 minutes prior to the surgical incision.

Adult↗

PubMedDate not supplied

Innovations in sterilization technology for instrument processing.

The past 5 years have seen the development of specialized devices to package, protect, and sterilize surgical instruments. The sterilization container system is one such innovative approach to operating room instrument processing. When compared with disposable and reusable systems, the sterilization container system was found to have the advantages of lower cost and improved efficiency.

Evaluation Studies as Topic↗

PubMed2006

Objectives for correction and related instrumentation strategies in scoliosis surgery for Lenke curve types 2, 3 and 5.

A recent study revealed a large variability among a group of 32 spine surgeons in the pre-operative instrumentation planning for the same 5 AIS patients. It is hypothesized that this variability may be attributed to different objectives for correction. In this new study we analyzed the objectives of correction and the related instrumentation strategies for three different Lenke curve types. Nine experienced surgeons from the Spinal Deformity Study Group were surveyed and asked to assess 11 different geometric parameters describing the spinal deformities for three different Lenke curve types (2, 3 and 5) according to their importance for an optimal 3D correction. These same 9 surgeons were asked to provide their preferred posterior instrumentation planning for three patients with the same curve types. Statistical analyses included: median, interquartile range IQR and Wilcoxon non parametric test. There was an overall agreement that sagittal and coronal balances were the most important parameters for an optimal correction. All other parameters were highly variable depending on the curve-type. Mobility was more important for the Lenke curve types 3 and 5 than for type 2 (p<0.032). A comparative analysis based on the coronal curves (Cobb) and the number of unfused vertebrae revealed a significant difference (p<0.025) between the correction objectives of the surgeons and their posterior instrumentation planning. In the three curves types analyzed, there is a large variability in scoliosis correction objectives, which is surgeon and curve-type dependent. There is a disagreement between the correction objectives and the instrumentation strategies. Optimal configuration of surgical instrumentation remains a controversial topic.

Adolescent↗

PubMed2004

Top level system developed.

Much attention in the healthcare engineering sector is focused on how the NHS programme for improving decontamination services will roll out. Shaping up is the way in which the private sector will be involved and in this article Nicholas Marshall examines a company's advanced system for cleaning and sterilising surgical instruments.

Decontamination↗

PubMed2005

Ongoing training importance stressed.

Paul Jenkins, senior training consultant, Eastwood Park, reflects on the forces which are creating an unprecedented demand for highly specialised ongoing training in the area of decontaminating reusable surgical instruments.

Decontamination↗

PubMed2004

[Giving birth to medical instruments: forceps and pelvimeters among obstetricians of the 19th century in Mexico].

Up until the mid-19th century, Mexican obstetricians associated forceps and other surgical instruments with risky operations, considering them artefacts whose use was to be avoided at all cost. This article asks why by the century's end these same instruments had come to be seen as life-saving surgical utensils. To this end, I analyzed clinical narratives that defined the norms and practices of their use, discovering that although forceps were redefined by male-midwives' norms of prudence, they also introduced medically-based ideas of gender and race and attributed to Mexican women's pelvises a supposedly pathological nature.

Equipment and Supplies↗

PubMed1977

Ergonomics applied to the practice of microsurgery.

Microsurgery presents special problems of visual information and fine manipulation, including tremor control. These problems can be studied usefully through ergonomics, the science of man at work, already used widely in industry. This paper presents factors affecting visual feedback, normal hand tremor, and instrument design, and refers to the process of skill acquisition and the care of surgical instruments.

Biofeedback, Psychology↗

PubMed1996

The harmonic scalpel: an intraoperative complication.

BACKGROUND: The harmonic scalpel is an ultrasonically activated surgical instrument for tissue dissection. Despite its expanding surgical applications, there are no reports about associated complications. CASE: A 35-year-old woman sustained injury to the sigmoid colon from the use of the harmonic scalpel during laparoscopic lysis of pelvic adhesions. The injury was identified and repaired laparoscopically in a primary fashion with no subsequent sequelae. CONCLUSION: Acoustic energy coupling and overheating of the laparosonic blade extender sheath occur with bending of the instrument. This can happen with steering of the blade extender during laparoscopic surgery and may increase the exposure risk of adjacent tissues to injury.

Adult↗

PubMed2007

Biomechanical study of anterior spinal instrumentation configurations.

The biomechanical impact of the surgical instrumentation configuration for spine surgery is hard to evaluate by the surgeons in pre-operative situation. This study was performed to evaluate different configurations of the anterior instrumentation of the spine, with simulated post-operative conditions, to recommend configurations to the surgeons. Four biomechanical parameters of the anterior instrumentation with simulated post-operative conditions have been studied. They were the screw diameter (5.5-7.5 mm) and its angle (0 degrees - 22.5 degrees), the bone grip of the screw (mono-bi cortical) and the amount of instrumented levels (5-8). Eight configurations were tested using an experimental plan with instrumented synthetic spinal models. A follower load was applied and the models were loaded in flexion, torsion and lateral bending. At 5 Nm, average final stiffness was greater in flexion (0.92 Nm/degrees) than in lateral bending (0.56 Nm/degrees) and than in torsion (0.26 Nm/degrees). The screw angle was the parameter influencing the most the final stiffness and the coupling behaviors. It has a significant effect (p < or = 0.05) on increasing the final stiffness for a 22.5 degrees screw angle in flexion and for a coronal screw angle (0 degrees) in lateral bending. The bi-cortical bone grip of the screw significantly increased the initial stiffness in flexion and lateral bending. Mathematical models representing the behavior of an instrumented spinal model have been used to identify optimal instrumentation configurations. A variation of the angle of the screw from 22.5 degrees to 0 degrees gave a global final stiffness diminution of 13% and a global coupling diminution of 40%. The screw angle was the most important parameter affecting the stiffness and the coupling of the instrumented spine with simulated post-operative conditions. Information about the effect of four different biomechanical parameters will be helpful in preoperative situations to guide surgeons in their clinical choices.

Biomechanical Phenomena↗

PubMed1997

Space, sterility and surgery: circuits of hygiene in the operating theatre.

The spaces of the surgical operating theatre (ST) and associated built environment are analysed, to explore what the physical layout means for the interactions which take place. Three "circuits of hygiene" of surgical staff, surgical instruments, and patients are documented, and analysis of these physical movements through the surgical spaces examined for their contribution to sterility. It is concluded that the built environment of the ST contributes reminders to staff to fulfil the necessary procedures of aseptic technique, to ensure the safe passage of the patient through surgery into a condition where s/he may be designated as "healed".

Asepsis↗

PubMed2006

Further bacteriological evaluation of the TOUL mobile system delivering ultra-clean air over surgical patients and instruments.

Two mobile TOUL-400 units (types 1 and 2) that produce an exponential ultra-clean air flow (EUA) via a mobile screen were evaluated (maximum height from floor to centre of screen: type 1, 1.4m; type 2, 1.6m). Bacterial deposition rates were lowered by >60% (P=0.001) over a table area of 1.7 m (length)x1.0m (width) with the TOUL-400 type 1 unit, and the mean air count at 1.0m from the screen was reduced from 23 to 1.6 colony-forming units (CFU)/m3 in experiments in a room with six air changes/h (ACH). The corresponding reductions were two- to three-fold greater in an operating room (OR) with 16 ACH due to higher bacterial contamination levels in the control experiments. The dramatic but localized reduction of the deposition rate recorded on one 14-cm settle plate (>2376-fold at 0.8m from the screen in the OR) apparently reflected the focus of the EUA. The impact of the TOUL-400 unit was underestimated by almost 100-fold by the air counts of bacteria recorded in parallel at the same sampling point (26.5-fold reduction). During sham coronary angiography and sham hip arthroplasty performed in a room with six ACH, ultra-clean air (<10 CFU/m3) was obtained over the incision area with the TOUL-400 type 2 unit when the EUA was undisturbed (maximum screen-wound distance 1.7 m). In actual coronary angiography (room with six ACH, screen-wound distance 2.0-2.3m) and various surgical procedures in the OR (screen-wound distance 1.4-1.8m), ultra-clean air was obtained at the wound in three of 18 instances, characterized by undisturbed air flow and a maximum distance of 1.8 m. The newly developed TOUL-300 surgical instrument table (1.3-1.7 x 0.6m), equipped at one end with the same EUA unit as the TOUL-400 unit, was evaluated for a room with six ACH and an OR with 16 ACH. It yielded ultra-clean air at 0.8m (1.9 CFU/m3, 96% reduction, P=0.01) and reduced the deposition rate by >60% over most of the table surface. Simplified positioning of the screen or a longer reach, plus a mechanism for precise focusing of the air flow on to the wound area would increase the clinical utility of the TOUL EUA system.

Air Microbiology↗

PubMed2002

Thomas Addis Emmet, the vesicovaginal fistula, and the origins of reconstructive gynecologic surgery.

Thomas Addis Emmet (1828-1919), the foremost pupil of J. Marion Sims and his successor as chief surgeon at The Woman's Hospital in New York City, was probably the pre-eminent American gynecological surgeon of the last quarter of the 19th century. Among his many achievements were the first critical study of vescovaginal fistula repair, authorship of the first modern scientific textbook of gynecology, the invention of numerous special surgical instruments, pioneering the use of surgical scissors in vaginal operations, and the development of "staged" procedures for surgical reconstruction of the vagina. He was an active writer, a renowned collector of American historical documents and memorabilia, a devout Catholic and a steadfast Irish patriot. This article reviews his life and contributions to gynecologic surgery.

Female↗

PubMed1999

Prions and the ENT surgeon.

Recent developments in our understanding of prion diseases have raised concerns for the public health. There is now compelling evidence that the transmissible agent for variant Creutzfeldt-Jakob disease (vCJD) in affected individuals is accumulated in lymphoreticular tissues such as the appendix and tonsils. This agent demonstrates a remarkable resistance to standard methods of sterilisation used in hospital sterile services departments. The possible implications this has on the safety of surgical instruments in ENT and other surgical practice is discussed. This review also outlines the history of our understanding of prion diseases and describes the development of a diagnostic test for vCJD in the living patient by pharyngeal tonsil biopsy.

Biopsy↗

PubMed1995

Thoracoscopy and video-assisted thoracic surgery in the treatment of lung cancer.

The contemporary surgical repertoire for the evaluation and treatment of patients with lung cancer includes the bronchoscope, mediastinoscope, thoracoscope, and standard surgical instrumentation. The recent advances in video optics and the development of endoscopic instruments have significantly expanded the surgical options for patients with lung cancer. Thoracoscopy, or the more inclusive term of video-assisted thoracic surgery (VATS), has been characterized as "minimally invasive" surgery. Thoracoscopy and VATS have decreased operative trauma and facilitated surgical staging prior to neoadjuvant therapy. An ancillary benefit to diminished surgical morbidity is shorter hospital stays with a concomitant reduction in costs to the patient and health-care system. These advantages make VATS ideal for elderly patients or patients with significant comorbidity.

Humans↗