Evaluation of a glutaraldehyde-phenate solution used to disinfect endoscopes and instruments in a freestanding surgical facility.
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Antisepsis↗
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Results for “Surgical Instruments”
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[Instruments and technique in surgical laparoscopy].
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Female↗
[Personally devised instrument for exposing the surgical field for tracheostomy and venesection].
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Bloodletting↗
A potential hazard of the use of the surgical ultrasonic aspirator in tumor reductive surgery.
The surgical ultrasonic aspirator (USA) is a recently developed surgical instrument being used for an increasingly wide range of surgical procedures including tumor reductive surgery in patients with advanced ovarian carcinoma. This paper introduces a potential hazard of the use of this instrument. It was determined that the mist produced by the ultrasonic aspirator during tumor reductive surgery contains intact and possibly viable cancer cells.
Adenocarcinoma↗
Arthroscopy of the hip.
Arthroscopy has become an important tool in the hands of orthopedic surgeons during the last decades. The hip joint is difficult to approach because it is located deep within the soft tissues covering it, thus decreasing the maneuverability of the instruments. With modern techniques, however, most of the joint space can be visualized. Today, there are several indications for hip arthroscopy and arthroscopic surgery to this joint. The surgical approach is usually made through 3 portals, one directly anterior, and two 2 cm proximal to the tip of the greater trochanter, one anteriorly and the other posteriorly. With a traction force of between 200 and 400 N applied to the leg, the joint space can be widened 5 to 10 mm, allowing space for visualization and surgical instruments. With good surgical technique, the complications are few, and the procedure produces little postoperative morbidity.
Arthroscopy↗
[Contribution of somatosensory evoked potentials in the surveillance of the spinal cord during spinal surgery].
This study shows the results obtained in 51 patients, children and adolescents by monitoring somatosensory evoked potentials during spinal surgery: Cotrel-Dubousset instrumentation, surgical anterior correction by plating, spondylolisthesis and hemivertebra surgery. The recordings were made in preoperative, peroperative and postoperative periods; the electro-physiological and anaesthetic conditions allowed us to obtain reliable recordings. Analysis of the peroperative somatosensory evoked potentials showed significant differences in latencies, but also in amplitudes and morphology during distraction in scoliosis or spondylolisthesis. These impairments gradually improved and recovered their normal values at the end of the operation. The impairments were, with equal correction, 4 times more important in Cotrel-Dubousset instrumentation than in surgical anterior correction by plating. In 3 cases, the modifications observed during instrumentation led the surgeon to change his operative behavior avoiding certainly a postoperative neurological disorder. The correlation between the neurological troubles and the impairments of the potentials allowed us to define alarm criteria, and if they persist the wake-test becomes necessary.
Adolescent↗
The new techniques of gynaecologic laparoscopy. Gasless, open Hasson, optic trocar.
BACKGROUND: New techniques of laparoscopy: gasless, open Hasson, optic trocars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alternative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery. METHODS DESIGN: Prospective evaluation. SETTING: University-affiliated county hospital. PATIENTS: Gasless laparoscopy surgery was performed on 49 patients between December 1995 and July 1996 with a retractor system without pneumoperitoneum consisting of an intrabdominal retractor using conventional surgical and laparoscopic instruments and to enable a simultaneous vaginal approach. RESULTS: Gasless laparoscopy was successful in 44 (90%) of cases. A simultaneous vaginal approach was used in one third of indications including vaginal myomectomy and laparoscopic assisted hysterectomy. Conversion to laparotomy was required in 5% of cases. Mean procedure duration was 90 minutes and mean hospitalisation time was 5.7 days. CONCLUSIONS: The introduction of new techniques of laparoscopy: gasless, open Hasson, optic trocars has broadened the application of operative laparoscopy. Gasless technique in lieu of conventional laparoscopy can be performed reliably and safely for most gynaecological indications. The most outstanding benefit of this method is that it can be combined with a vaginal approach which is not possible using a pneumoperitoneum due to gas leakage. The place of gasless laparoscopy will depend on continuing development by instrument manufacturers, in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.
Female↗
Clinical and research aspects of subtotal open-sky vitrectomy. XXXVII Edward Jackson Memorial Lecture.
Subtotal open-sky vitrectomy can be used to improve visual function in some eyes for which closed vitrectomy is useless. Open-sky vitrectomy allows easier access for surgical instruments, especially to anterior fundus structures. The technique also improves the visibility of intraocular structures. The surgical procedure, which uses special instruments and high-molecular-weight hyaluronic acid, is divided into four stages: preparation, operating inside the vitreous cavity, wound closure, and retinal reattachment. In 290 consecutive operations for which complete follow-up data are available, retinal reattachment was achieved in 61 eyes (21%). The greatest number of successes (16 of 30 cases [53%]) was achieved in severe tractional retinal detachments. Such results are encouraging because these eyes were considered inoperable by other techniques. Open-sky vitreous surgery is performed through a corneal incision, but a scleral incision over the pars plana may become the method of choice in selected cases. The development of a preretinal fibrin membrane, as a result of either a closed vitrectomy or an open-sky procedure, may be a major cause of postoperative failure. Hypotony during surgery is probably the main precipitating factor of intraocular fibrin membrane formation.
Adolescent↗
The first British illustrated surgical catalogue.
Surgical instrument catalogues are valuable documents, which help in both the identification and dating of instruments. A rare copy of the first British illustrated surgical catalogue was offered for sale in 2003. This paper gives brief details of the catalogue and its author, JH Savigny.
Catalogs as Topic↗
Relation between patient positioning, trunk flexibility and surgical correction of the scoliotic spine.
The purpose of this work is to investigate the relations between the correction of idiopathic scoliosis obtained by surgical instrumentation and the positioning of the patient on the surgical table as well as the curve reduction following the bending test. A retrospective study of preoperative standing, supine and lateral bending films as well as postoperative standing films was made using multiple regressions in order to identify the most significant parameters and define linear statistical models to predict the surgical correction. Postoperative thoracic Cobb angle is significantly associated to left and right bending Cobb angles and the post-op lumbar Cobb is associated to the supine and the left bending Cobb angles. This preliminary study suggests that such parameters should be considered in the pre-operative planning of surgery as well as in biomechanical models to obtain more adequate predictive values of the surgical outcome and to better understand the biomechanics of scoliosis surgical correction.
Adolescent↗
The OSHA bloodborne pathogens standard.
1. The OSHA Standard is intended to reduce the risks to health-care workers of exposure to bloodborne pathogens. Because the patient's HIV or HBV status is often unknown, the Standard focuses on reducing the risks of exposure to blood and those body fluids to which universal precautions apply. 2. Engineering and work practice controls to reduce the risk of exposure include techniques for handling, cleaning, and decontaminating instruments with minimal hand contact; using containers to pass surgical instruments; wearing puncture-resistant gloves; and using forceps or clamps to remove scalpel blades from knife handles. 3. Employers must provide personal protective equipment at no cost. This equipment must prevent blood or other potentially hazardous materials from passing through or reaching employee's work or street clothes, skin, eyes, mouth, or other mucous membranes during normal conditions for the duration of time used.
Acquired Immunodeficiency Syndrome↗
Lasers in pediatric surgery.
Lasers, once a laboratory curiosity, have quickly become a viable and valuable surgical instrument. They have been found useful in almost every surgical specialty. This chapter will discuss how laser light is produced and its effects on tissue. The various laser types are discussed, and their clinical implications are reviewed. Most important, we also review the hazards associated with these systems and the ramifications of their use. The perioperative nurse must be familiar with the various protocols used in treating patients with lasers, applications of the lasers, and specific safety requirements.
Child↗
Robotic cardiac surgery: overview.
Most endoscopic procedures are excisional, not reconstructive or microsurgical, mostly because conventional endoscopic instrumentation lacks dexterity due to long, nonarticulated instruments, a fixed pivot point and counterintuitive movement of the instrument tip, and lack of depth perception. Endoscopic approaches to cardiac surgery have not been successful; however, the development of robotic surgical systems has overcome many limitations of endoscopy. Computer-assisted surgery has created a computerized digital interface between the surgeon's hands and surgical instrument tips and enhances surgical ability, thereby enabling endoscopic microsurgery. Recently, robotic systems have allowed cardiac surgeons to perform minimally invasive endoscopic coronary artery bypass grafting (CABG) and valve procedures. This article summarizes the use of robotics in cardiac surgery and discusses its potential in our specialty.
Cardiac Surgical Procedures↗
Percutaneous injuries during surgical procedures.
OBJECTIVE: To study the numbers and circumstances of percutaneous injuries (eg, needle sticks, cuts) that occur during surgical procedures. Surgical personnel risk infection with blood-borne pathogens from percutaneous injuries; some injuries might also place patients at risk by exposing them to a health care worker's blood. DESIGN: Observers present at 1382 surgical procedures recorded information about the procedure, the personnel present, and percutaneous injuries that occurred. SETTING: Four US teaching hospitals during 1990. PARTICIPANTS: Operating room personnel in five surgical specialties. MAIN OUTCOME MEASURES: Numbers and circumstances of percutaneous injuries among surgical personnel and instances in which surgical instruments that had injured a worker recontacted the patient's surgical wound. RESULTS: Ninety-nine injuries occurred during 95 (6.9%) of the 1382 procedures. Seventy-six injuries (77%) were caused by suture needles and affected the nondominant hand (62 injuries [63%]), especially the distal forefinger. The risk of injury adjusted for confounding variables by logistic regression was higher during vaginal hysterectomy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.5) and lower during certain orthopedic procedures (OR, 0.2; CI, 0.1 to 0.7) than during 11 other types of procedures (reference group; OR, 1.0). Use of fingers rather than an instrument to hold the tissue being sutured was associated with 35 injuries (35%). Eighty-eight injuries (89%) were sustained by resident or attending surgeons; in 28 (32%) of the 88 injuries in surgeons, the sharp object that caused the injury recontacted the patient. CONCLUSION: Percutaneous injuries occur regularly during surgery, placing surgical personnel and, to a lesser extent, patients at risk for infection with blood-borne pathogens. Many such injuries may be preventable with changes in devices, techniques, or protective equipment; all such measures require careful evaluation to determine their efficacy in reducing injury and their effect on patient care.
Accidents, Occupational↗
Nose: aesthetics and function. Rhinoplasty and functional problems related to anterior ethmoid.
Aesthetic nasal surgery has progressed in the last years, as concerning both surgical techniques and surgical instruments, which allowed the finding of new and more sophisticated surgical solutions. Clinical practice led to observe sometimes functional surgical failures, due rather than an inaccurate surgical technique, to an incomplete diagnostic approach to the patient. It has been observed that modifying the external conformation of nasal pyramidis inner-nose volumes and spaces will be subsequently reduced, giving as a result a condition which is only aesthetically but not functionally valid. 32 subjects, selected for a rhinoplasty and presenting nasal respiratory obstruction and anterior ethmoid abnormalities, confirmed by nasal endoscopy and nasal CT, were evaluated and subdivided into two groups: the first (A) group underwent only to an aesthetic rhinoplasty, the second group (B) was operated of a rhinoplasty combined with functional endoscopic sinus surgery (FESS) in order to correct the above mentioned anatomical abnormalities. The nasal airflow, and though the nasal cavities patency, was evaluated pre- and post-operatively in the two groups of patients, referring to rhinomanometric conductance values. Patients of group A reported decreased post-operative conductance values, patients of group B reported increased post-operative conductance values, showing though the functional involvement of anterior ethmoid in nasal obstruction and the necessity of correcting its anatomical abnormalities, in order to reach not only a new nasal profile, but also a better respiratory performance.
Adolescent↗
Biomechanical analysis and simulation of scoliosis surgical correction.
In scoliosis, presurgical determination of each patient's segmental spinal stiffness will permit model simulation of the surgical correction. It also permits calculation of the optimal combination of corrective forces applied to the spine by the internal fixation system. This information can help to optimize the surgical procedure, especially if calculated forces and corrections can be monitored during surgery. To this end, a finite-element model of the spine has been developed that determines segmental stiffness from data of spinal geometries, derived from the radiographs of the patient, taken with incremental distraction applied to the head. On this model, custom-tailored combinations of corrective forces are applied incrementally until optimal correction is obtained, for safe levels of distraction and lateral forces. With variations in the computer software, any desired surgical instrumentation system can be simulated. Instrumented distractor and compression forceps have been fabricated to monitor surgical forces and displacements, and to permit eventual implementation of the model recommendations. Comparison of surgically acquired correction with that predicted by the model is then carried out. Data on complete analysis of two cases of idiopathic scoliosis are presented. They show significant variations in segmental and interpatient stiffness values, and how spinal stiffness governs the amount of correction gained by the nature and magnitude of corrective forces.
Adult↗
[Management of infected wounds and trophic ulcers by low frequency ultrasound].
The article is devoted to the investigation of the use of low frequency ultrasound surgical instrument in treatment of trophic ulcers and infected wounds in surgical patients. The method of treatment of these wounds and ulcers by cavitation influence through an intermediate medium was established, an ultrasound surgical apparatus "SUSA-2lf.02", being used, which has been developed and manufactured by AOZT "Medilen"--(St Petersburg). On the base of the experience in treatment of 76 patients intensification of diffusion of the medical preparations into the tissues was shown, among them--into the deep layers of the wound channel. The application of ultrasound provides favourable metabolic changes (normalization of pH of the medium), ensures deep diffusion of medicamentous preparations into the tissues surrounding the ulcers, and enhances therapeutic activity of the preparation.
Adult↗
[Image-guided endoscopic sinus surgery: a comparison of two navigation systems].
We evaluated the effectiveness of two navigation systems with optical tracking in endoscopic sinus surgery (ESS). The Signa SP/i Intraoperative navigation system (General Electric Co., Intraoperative NS) is advantageous in acquiring both real time and high-resolution images during surgery, compared to conventional image-guided navigation (Stealth Station TREON, Medtronic Inc., IGNS) that rely entirely on preoperative three-dimensional images. We studied the following in 14 patients treated with intraoperative NS and 19 treated with IGNS: 1) additional time for navigation system implementation, 2) available instrumentations in ESS, and 3) navigation system accuracy. Navigation systems required additional time to prepare ESS. The time lapse from admittance to the operating room to ESS onset was measured in patients under both systems and controls undergoing ESS without any image guidance. Preparation of the intraoperative NS required an additional 52 min and IGNS required 17 min compared to the control group. Based on operative instruments, the intraoperative NS has some limitations arising from the application of a high magnetic field. Surgical instruments must not be attracted by the magnetic field in the operating room. So those used in our study were thoroughly examined and some remanufactured using MR safe materials. All instruments in ESS could be used in surgical guidance during surgery in the IGNS. Anatomic landmarks were accurately visualized using intraoperative NS and IGNS. Intraoperative NS renews the image during surgery, so surgeons could confirm the surgical outcome during ESS. Since the average distant error in both systems was between 1 mm and 2.5 mm, we confirmed that accuracy obtained with both navigation system was suitable for ESS completion. The intraoperative NS renewed the image during navigation. In conclusion, both navigation systems are sufficient for accurate image navigation in ESS, but navigation systems must be selected based on the individual case.
Endoscopy↗