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Anaesthesia for minimally invasive neurosurgery.
Technological advances in imaging, computing and surgical instrumentation have encouraged the application of minimally invasive surgical techniques to various neurosurgical disorders. This chapter discusses the wide application of neurosurgery and the implications for anaesthesia, focusing on the specific anaesthetic considerations for neuroendoscopy, stereotactic procedures and radiosurgery.
Robotically assisted gynaecological surgery.
Industry has used robots successfully for fine, delicate, repetitive tasks for decades. Recently, robots have been introduced into clinical medicine and specifically into the surgical suite. Voice algorithms have been developed that allow voice activation of some types of equipment in the operating room, such as the laparoscope or the light source. Advances in computer software have allowed a computer controller to translate a surgeon's movements from the handles located in a console to the robotic arms that hold the surgical instruments. This console is placed away from the surgical table. Clinical experience is limited and there are few published clinical trials. The initial trials have focused on laparoscopic microsuturing such as that performed during coronary bypass surgery or tubal anastomosis. Preliminary results have demonstrated that laparoscopic coronary bypass surgery with the internal mammary artery can be achieved. In gynaecological surgery, laparoscopic tubal reanastomosis can be performed using the same technique that has been used traditionally at laparotomy. Future clinical trials will assess whether other gynaecological procedures can be performed with robotic assistance.
DRAWN-UP PUPIL AFTER CATARACT SURGERY.
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Long-term results of the Lothrop operation.
With continued surgical instrument advancement, endoscopic sinus surgery techniques continue to evolve with an overall improvement of our ability to offer surgical treatment for a variety of surgical disorders of the sinuses and anterior skull base. Frontal sinusitis and the extent of surgery performed in the frontal recess once medical management fails are constantly debated in the literature. It seems that even though instrumentation has greatly improved, surgical management of frontal sinusitis remains a frustrating endeavor for otolaryngologists. Open approaches to the frontal sinus, including the osteoplastic flap with frontal sinus obliteration using adipose tissue, have been the gold standard, but require external incisions and complete removal of sinus mucosa with destruction of the frontal sinus. The endoscopic modified Lothrop technique involves removal of the frontal sinus floor bilaterally with frontal septectomy and resection of the nasal septum to create a large nasofrontal communication. Recent postoperative results of this technique rival the results after frontal sinus obliteration in selected patients while avoiding the morbidity associated with the open destructive approach.
PARTIAL CYCLECTOMY. SOME FURTHER MODIFICATIONS IN TECHIQUE.
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LOCALIZING THE RETINAL HOLE IN THE SURGICAL TREATMENT OF RETINAL DETACHMENT.
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The Elite II Bariatric Surgery Retractor system: a recent addition to the bariatric surgeon's tool chest.
BACKGROUND: A good surgical retractor is essential for facilitating bariatric surgery. Recently, Thompson Surgical Instruments designed a new system specifically for bariatric surgical procedures. METHODS: The Elite II Bariatric Retractor system was evaluated in 50 successive bariatric surgical patients. We had the opportunity to modify and improve several major components. We report our experience with this modified retractor system. RESULTS: This system proved to be safe, easy to use, durable, and useful in patients of all BMIs, following modifications and improvements to standard parts. CONCLUSION: This new bariatric retractor system is an improvement over prior bariatric retractor systems being used.
Virtual reality based surgical assistance and training system for long duration space missions.
Access to medical care during long duration space missions is extremely important. Numerous unanticipated medical problems will need to be addressed promptly and efficiently. Although telemedicine provides a convenient tool for remote diagnosis and treatment, it is impractical due to the long delay between data transmission and reception to Earth. While a well-trained surgeon-internist-astronaut would be an essential addition to the crew, the vast number of potential medical problems necessitate instant access to computerized, skill-enhancing and diagnostic tools. A functional prototype of a virtual reality based surgical training and assistance tool was created at our center, using low-power, small, lightweight components that would be easy to transport on a space mission. The system consists of a tracked, head-mounted display, a computer system, and a number of tracked surgical instruments. The software provides a real-time surgical simulation system with integrated monitoring and information retrieval and a voice input/output subsystem. Initial medical content for the system has been created, comprising craniofacial, hand, inner ear, and general anatomy, as well as information on a number of surgical procedures and techniques. One surgical specialty in particular, microsurgery, was provided as a full simulation due to its long training requirements, significant impact on result due to experience, and likelihood for need. However, the system is easily adapted to realistically simulate a large number of other surgical procedures. By providing a general system for surgical simulation and assistance, the astronaut-surgeon can maintain their skills, acquire new specialty skills, and use tools for computer-based surgical planning and assistance to minimize overall crew and mission risk.
TRANSDUODENAL OPERATIONS ON THE COMMON DUCT.
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[GENERAL ANESTHESIA IN TONSILLECTOMY AND ADENOIDECTOMY. GENERAL ANESTHESIA WITH CONTROLLED HYPOTENSION IN MICROSURGERY OF THE EAR].
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[ATRAUMATIC NEEDLES MOUNTED ON FINE THREADS, 8 ZERO (3 AND 7 FILAMENTS OF SILICONIZED VIRGIN SILK)].
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[A RAPID SUTURELESS METHOD IN THE SURGICAL TREATMENT OF TRACHOMATOUS ENTROPION-TRICHIASIS].
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UTERINE CLAMP FOR USE IN TUBOPLASTIC OPERATIONS.
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AN IMPROVED SURGICAL RETRACTOR.
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[CONSIDERATIONS ON THE TREATMENT OF RECTAL PROLAPSE IN THE CHILD AND IN THE ADULT].
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