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At least 73 records · Page 4Linked to original sources
PubMed1997

Development and application of ultrasonic surgical instruments.

In this paper, a new approach for designing ultrasonic surgical instruments (USI) is presented. These medical instruments convert an ultrasonic signal into a mechanical vibration by utilizing a magnetostrictive method and have been found to be very useful for various medical procedures. The implemented system consists of an ultrasonic generator, a transducer, and waveguide instruments. The generator produces a high-current ultrasonic signal. The transducer converts this signal into a mechanical vibration. By use of the waveguide instrument, the vibration can be propagated and amplified. This new type of USI possesses a comprehensive ability to stop bleeding, cut bone tissues, regulate frequency automatically, control temperature, etc. The results from animal experiments and from human clinical operations show that the developed USI has the advantages in various aspects over the conventional equipment.

Abdominal Muscles↗
PubMed2004

Prospective trial of gasless laparoscopic Burch colposuspension using conventional surgical instruments.

STUDY OBJECTIVE: To prospectively evaluate the use of gasless laparoscopy techniques in the performance of a traditional Burch colposuspension in women with urodynamically-demonstrated genuine stress incontinence and urethral hypermobility. DESIGN: Multicenter, prospective, single-intervention series (Canadian Task Force Classification II-2). SETTING: Three urogynecologic referral centers. PATIENTS: Fifty-eight women. INTERVENTION: Traditional Burch colposuspension performed utilizing gasless laparoscopic access and conventional surgical instruments. MEASUREMENTS AND MAIN RESULTS: Follow-up was 12 to 38 months. On pad testing, urine loss was significantly reduced, from 6.0 g (CI: 0.55-11.45) to 0.3 g (CI: 0-1.53). Average daily incontinence episodes based on 7-day voiding diaries decreased from 4.7 (CI: 0.87-8.53) to 0.3 (CI: 0-1.58). Q-tip angles were normalized: 49.8 degrees (CI: 40.86-58.74) to 10 degrees (CI: 1.49-18.51). Ninety-five percent of subjects reported resolution of stress incontinence. Three subjects (5%) reported recurrent/persistent genuine stress incontinence: one was operated on during the postpartum period while breastfeeding, and two developed intrinsic sphincteric deficiency postoperatively. Fifty-five percent of subjects underwent other pelvic reconstructive surgery including posterior wall repairs. Average operative time was 60.8 minutes (range, 40-92). The ideal candidate has an unscarred abdominal wall. CONCLUSION: Gasless laparoscopic access was used to effectively perform traditional Burch colposuspension using conventional open surgical instruments. Bladder neck hypermobility was normalized in all subjects, and 95% of subjects reported no further stress incontinence.

Adult↗
PubMed2004

The relationship between hand size and difficulty using surgical instruments: a survey of 726 laparoscopic surgeons.

BACKGROUND: Hand size is an important variable to consider when designing hand tools. Laparoscopic surgical instruments have been reported to cause hand and upper extremity discomfort. This study investigates the correlation between surgical glove size, preexisting musculoskeletal problems, and difficulty using laparoscopic instruments. METHODS: Approximately 11,000 questionnaires were sent to SAGES, AAGL, and AWS members. Questions included basic demographic and practice data, surgical glove size, the presence of musculoskeletal problems, and the perceived difficulty using several types laparoscopic instruments. There were 726 responses (from 159 women and 567 men). Subjects were grouped by hand size (Small < or =6.5, Medium 7.0-7.5, Large >7.5; female group only: Small < or =6.0, Medium 6.5, Large >6.5). ANOVA was used to test for differences between groups. RESULTS: The percentage of time subjects reported having difficulty using all laparoscopic instruments was greater for the Small glove size group compared to both the Medium and Large groups ( p < 0.001). In females, the scissors and staplers were more difficult to use for the Small and Medium glove size group compared to the Large group ( p < 0.001). Subjects who reported musculoskeletal problems ( n = 145) performed a significantly greater percent of laparoscopic cases and found the stapler and graspers difficult to use for a greater percentage of time than those not reporting problems ( n = 559). CONCLUSION: Hand size is a significant determinant of difficulty using laparoscopic surgical instruments. Individuals using glove sizes 6.5 or smaller experience significantly more difficulty using common laparoscopic instruments, and in particular laparoscopic staplers. Manufacturers of surgical hand tools should consider hand size when designing future surgical instruments.

Adult↗
PubMed1982

Efficient storage of sterilized ophthalmic surgical instruments.

To solve the problem of efficient storage of sterilized ophthalmic surgical instruments, we devised a system that uses backloading hooks and cross-indexing of instruments by number together with the mounting of the instruments by number on a pegboard system.

Humans↗
PubMed2005

[Nursing undergraduates' anxiety about the first surgical instrumentation].

This study aimed to identify nursing undergraduates' anxiety about the first surgical instrumentation. The sample consisted of 30 sixth-period students who were enrolled in the subject surgical nursing. Data were collected through the STAI (State-Trait Anxiety Inventory). We identified that 90% of the students demonstrated low levels of trait anxiety. As to state anxiety, the most frequent observations were: low anxiety level on the first day of theoretical class (76.7%). medium anxiety level at the lab (53%) and medium anxiety level during supervised training (80%). Furthermore, we identified a small number of students with high anxiety levels. The statistical analysis shows significant differences among the mean levels of state-anxiety during the three data collection phases.

Anxiety↗
PubMed2004

Spinal shape changes resulting from scoliotic spine surgical instrumentation expressed as intervertebral rotations and centers of rotation.

This paper reports the changes in spinal shape resulting from scoliotic spine surgical instrumentation expressed as intervertebral rotations and centers of rotation. The objective is to test the hypothesis that the type of spinal instrumentation system (Cotrel-Dubousset versus Colorado) does not influence these motion parameters. Intervertebral rotations and centers of rotation of the scoliotic spines were computed from the pre- and post-operative radiographs of 82 patients undergoing spinal correction. The three-dimensional (3D) reconstruction of six anatomical landmarks was achieved for each of the thoracic and lumbar vertebrae. A least-squares approach based on singular value decomposition was used to calculate the rigid body transformation parameters. Average centers of rotation for all intervertebral levels are located in the neural canal at the mid-sagittal plane and approximately at the superior endplate level of the inferior vertebra. Intervertebral rotations have components in all planes: 6.7 degrees (frontal), 5.5 degrees (sagittal) and 4.5 degrees (transverse) RMS for all intervertebral levels. Nearly all intervertebral rotations and centers of rotation are not significantly different for the two instrumentation systems. Various intervertebral rotations and 3D reconstruction errors were simulated on a theoretical model of a lumbar functional unit to assess the proposed method. Intervertebral rotation errors were 1.7 degrees when simulating 3D errors of 3mm on the position of the landmarks. Maximum errors for the position of centers of rotation were below 1cm in the case of intervertebral rotations larger than 2.5 degrees (most cases), but were larger (38 mm) for small intervertebral rotations (<1 degrees ). The type of instrumentation system did not influence intervertebral rotations and centers of rotation. These results provide valuable data for the development and validation of simulation models for surgical instrumentation of idiopathic scoliosis.

Adult↗
PubMed1998

Historical development of surgical instruments exemplified by hemostatic forceps.

We describe the historical development of surgical instruments exemplified by hemostatic forceps, starting with antique and medieval forceps used for the arrest of bleeding to modern atraumatic hemostatic forceps used for vascular reconstruction. Their development proceeded mainly in three steps: (1) development of ligature forceps directly for hemostasis (Celsus, first century AD; Paré, 1582; L. Heister, 1743; (2) development of atraumatic forceps, which facilitate vascular reconstruction or anastomosis creation by temporarily clamping vessels (Höpfner, 1903; Stich, 1907; Jeger, 1913; (3) construction of tangential forceps, which, by partially clamping vessels with partial maintenance of blood flow, allow the reconstruction or anastomosis of large vessels in a side-to-side technique. The first tangential occlusion clamp was developed by Friedrich Trendelenburg (1844-1924) in 1908, when he established the operative treatment for embolism of the pulmonary artery. This clamp was later modified by A. W. Meyer (1927) and V.P. Satinsky (ca. 1950).

Hemostasis, Surgical↗
PubMedDate not supplied

Long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy: how suitable and useful are conventional surgical instruments?

PURPOSE: To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. METHODS: Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. RESULTS: Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. CONCLUSIONS: IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach.

Adult↗
PubMedDate not supplied

[Surgical instruments in pelvic fractures and dislocations].

The paper presents kits of 5 original surgical instruments successfully used in (internal) osteosynthesis of the pelvis for various complex fractures and dislocations of its bones in different regions. Four instruments of them have no analogues. The design of each kit takes into account the specific features of the geometry and outlines of the pelvic ring.

Evaluation Studies as Topic↗
PubMedDate not supplied

Transmission electron microscopy: evaluation of damage in human oviducts caused by different surgical instruments.

Different wave length lasers (CO2, Nd-YAG, KTP-532), electrocautery and radiofrequency instruments were used to assess the degree of tissue damage in human oviducts. Excision of the human fallopian tube for tuboplasty is achieved most often by electrocautery, scalpel and, more recently, the Carbon Dioxide (CO2) Laser. There is not enough evidence at the present time to scientifically justify using one particular mode of incision which would show minimal damage to surrounding healthy tissue, especially heat lateral damage. The present study compares the tissue damage produced by the microelectrocautery, the CO2, the KTP-532, the Nd-YAG lasers and the radiofrequency surgical instrument, utilizing different power densities on the fallopian tubes freshly removed at the isthmic portion, taken from healthy women ages 30-42. Transmission electron microscopy sections at the cellular level show that the electrosurgical radiofrequency surgical instrument produces the least damage to surrounding healthy tissue. The CO2 laser with intermittent superpulse mode showed the second lowest amount of damage. The most damage was observed with the Nd-YAG laser at high power densities.

Adult↗
PubMed2006

Factors determining the potential for onward transmission of variant Creutzfeldt-Jakob disease via surgical instruments.

While the number of variant Creutzfeldt-Jakob disease (vCJD) cases continues to decline, concern has been raised that transmission could occur directly from one person to another through routes including the transfer of blood and shared use of surgical instruments. Here we firstly present data on the surgical procedures undertaken on vCJD patients prior to onset of clinical symptoms, which supports the hypothesis that cases via this route are possible. We then apply a mathematical framework to assess the potential for self-sustaining epidemics via surgical procedures. Data from hospital episode statistics on the rates of high- and medium-risk procedures in the UK were used to estimate model parameters, and sensitivity to other unknown parameters about surgically transmitted vCJD was assessed. Our results demonstrate that a key uncertainty determining the scale of an epidemic and whether it is self-sustaining is the number of times a single instrument is re-used, alongside the infectivity of contaminated instruments and the effectiveness of cleaning. A survey into the frequency of re-use of surgical instruments would help reduce these uncertainties.

Creutzfeldt-Jakob Syndrome↗
PubMed1997

A new surgical instrument for diathermic conization of the uterine cervix.

A surgical instrument for uterocervical diathermic conization has been constructed for adequate treatment of patients with mild to severe dysplasia (CIN I-III) of the uterine cervix. The purpose of the instrument is to provide a simple means of performing a differentiated conization tailored to the anatomy of the patient and the extent of the disease. With this instrument conization of the uterine cervix may be performed on an out-patient basis. It includes a mount holder member for a diathermic wire that fits into a pistol grip. The wire is held in tension by the mount so that the wire forms an angle alpha to the longitudinal axis of the mount. The wire then cuts out a cone when the mount is turned through a complete revolution. Angle alpha of the wire may be adjusted on the mount thus enabling variation in the size and shape of the cone that is excised.

Cervix Uteri↗
PubMed2005

Surface exploration using laparoscopic surgical instruments: the perception of surface roughness.

During laparoscopic surgery video images are used to guide the movements of the hand and instruments, and objects in the operating field often obscure these images. Thus, surgeons often rely heavily on tactile information (sense of touch) to help guide their movements. It is important to understand how tactile perception is affected when using laparoscopic instruments, since many surgical judgements are based on how a tissue 'feels' to the surgeon, particularly in situations where visual inputs are degraded. Twelve naïve participants used either their index finger or a laparoscopic instrument to explore sandpaper surfaces of various grits (60, 100, 150 and 220). These movements were generated with either vision or no vision. Participants were asked to estimate the roughness of the surfaces they explored. The normal and tangential forces of either the finger or instrument on the sandpaper surfaces were measured. Results showed that participants were able to judge the roughness of the sandpaper surfaces when using both the finger and the instrument. However, post hoc comparisons showed that perceptual judgements of surface texture were altered in the no vision condition compared to the vision condition. This was also the case when using the instrument, compared to the judgements provided when exploring with the finger. This highlights the importance of the completeness of the video images during laparoscopic surgery. More normal and tangential force was used when exploring the surfaces with the finger as opposed to the instrument. This was probably an attempt to increase the contact area of the fingertip to maximize tactile input. With the instrument, texture was probably sensed through vibrations of the instrument in the hand. Applications of the findings lie in the field of laparoscopic surgery simulation techniques and tactile perception.

Adult↗