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At least 883 records · Page 49Linked to original sources
PubMed1988

Airway management in the resuscitation of trauma patients.

Airway management in resuscitation of the traumatized patient is a complex and challenging area for the health care provider and the medical engineer involved in the improvement of airway management instrumentation. Surgical and nonsurgical airway management is discussed, with emphasis placed on the instrumentation available and its appropriate uses and limitations. Suggestions for areas requiring new innovations are included.

Airway Obstruction↗
PubMed1999

Electron spin resonance (ESR) probe for interventional MRI instrument localization.

This article presents a miniaturized electron spin resonance (ESR) probe for deducing the position of a surgical instrument on an MR image. The ESR probe constructed was small enough to fit inside a 14-G biopsy needle sheath, and position information of the sheath could be acquired using a simple gradient sequence. The position accuracy was estimated from needle trajectories as inferred from the needle artifact, the actual physical trajectory, and measured coordinates. The probe was able to track the tip of a biopsy needle quickly (10 samples/sec) and precisely with accuracy better than +/-2 mm. J. Magn. Reson. Imaging 1999;10:216-219.

Artifacts↗
PubMed1989

Tracheostomy in the intensive care unit: a safe alternative to the operating room.

Severely injured patients frequently require endotracheal intubation, either by the nasotracheal (NT) or orotracheal (OT) route, for airway control and/or ventilatory support. If intubation is required for more than two to four weeks, an elective tracheostomy is usually indicated. Transferring these patients to the operating room is difficult, and it impairs their continued monitoring and care. Over a period of 48 months at our institution, 74 patients had tracheostomy done in the intensive care unit (ICU) by a surgical resident (PG2 level) assisted by a chief resident or attending faculty member. Local anesthesia was supplemented with intravenous sedatives, and operating room technique was used, with complete surgical instrument pack and adequate lighting. There were no deaths from the procedure. There were no complications specifically attributed to the performance of tracheostomy in the ICU, though one patient each suffered tracheitis, tracheostomy tube dislodgement, and tracheomalacia. Tracheostomy in the ICU avoids the risks of moving these patients with all their monitoring and infusion lines, and saves operating room time and charges. Trained surgical personnel using adequate instruments and lighting can safely perform a tracheostomy in the intensive care unit.

Combined Modality Therapy↗
PubMed1977

A simplified model for teaching minor oral surgery.

A teaching model, specially constructed for the purpose of training senior dental students in the use of surgical instruments, is described. The advantages of this model are inexpensiveness and reproducible simulated surgical situations securing a uniform teaching objective.

Education, Dental↗
PubMedDate not supplied

New opportunities for cutting with lasers.

Laser microcutting is a leading technology for the manufacture of surgical instruments and medical implants. This article assesses its capabilities for stents and surgical-needle manufacture and for other tube-cutting applications that require microscaled designs.

Computer-Aided Design↗
PubMed2006

Computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails: a preliminary report on clinical application.

OBJECTIVE: To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails. METHODS: The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330. RESULTS: All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s. CONCLUSIONS: The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.

Adult↗
PubMed1988

Educational needs in patient care practices in Hong Kong.

We conducted a survey on staff perceptions of what the educational needs would be for an infection surveillance and control program in patient care practices in 10 hospitals in Hong Kong. Seven hundred twenty nurses were interviewed and were requested to select their needs from six topics: isolation procedures, disinfection of environment and instruments, surgical wound care, urinary catheter care, prevention of hospital-acquired pneumonia, and prevention of infusion therapy sepsis. According to their pattern of needs, the clinical units could be divided into three groups. Staff members in the "medically oriented units," consisting of the medical, geriatric, obstetric, and intensive care units, indicated that their greatest needs were in the areas of isolation procedures and disinfection of environment and instruments, whereas nurses in the "surgically oriented units," consisting of surgical, orthopedic, and gynecologic units, indicated that surgical wound care was the area where education was most needed. The pattern in the third group, the pediatric units, was similar to that of medical units in indicating isolation procedures and disinfection of environment and instruments as the greatest needs but differed in having a higher score for prevention of hospital-acquired pneumonias and a lower score for surgical wound care. An effective educational program should take these needs into consideration. We discuss the application of the survey findings in planning in-service education in infection control.

Cross Infection↗
PubMed2006

Mentoring console improves collaboration and teaching in surgical robotics.

BACKGROUND: One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. MATERIALS AND METHODS: The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. RESULTS: Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P < 0.01) and by 34% compared to single-resident operation (P < 0.001). While swap mode was found to be most helpful during parts of surgical procedures that require multiple hands (such as isolation and division of vessels), nudge mode was particularly useful for guiding a resident's hands during crucially precise steps of an operation (such as proper placement of stitches). CONCLUSION: The da Vinci mentoring console greatly facilitates surgeon collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

Animals↗
PubMed2004

What can the operator actually feel when performing a laparoscopy?

The designing of a laparoscopic simulator, particularly the parameterizing of a force feedback system, has drawn attention to the question of characterizing laparoscopic gestures and effecting quantitative measurement of the various interactions between the organs and the instruments used to operate in the case of animals. These measurements use an instrument previously developed by the authors' team. Laparoscopic gestures are characterized by a visual component and a haptic component. The visual component cannot, of course, be disregarded. The amplitude of the forces generated by interaction between organ and instrument in relation to that of the forces linked with other mechanical phenomena interfering with somesthesic information, such as friction of the operative instrument in the trocar or resistance of the abdominal wall to tilting movement, has led to a discussion about the extent of haptic components involved in the performance of laparoscopic gestures. After describing the measurement's device and the different forces applied on the surgical instrument, the authors describe the measurement of the rubbing strengths caused by the slippage of the instrument in the trocar and one of the elastic torques induced by the abdominal wall when the trocar in slanted. Comparison of values with those obtained during interactions with various organs shows that during some delicate surgical gestures, the influence of the instrument can disturb the haptic sensation. Interference of haptic sensation is greatest at maximal tilting angles and at maximal velocity of insertion and removal movement.

Animals↗
PubMed1992

Apparent pacemaker failure caused by activation of ventricular threshold test by a magnetic instrument mat during general anaesthesia.

A patient with a permanent pacemaker underwent radical neck dissection. After induction of anaesthesia, a magnetic surgical instrument mat was placed over the patient's chest. This caused the pacemaker to go into a threshold test which included a 2.5-s period of asystole. Surgery had to be abandoned temporarily. We suggest that magnetic instrument mats should not be used with pacemaker patients; not all pacemakers are converted to a fixed magnetic rate by application of a magnet. The anaesthetist should check to see if the patient has a pacemaker with a threshold test and, if possible, this should be rendered inactive.

Aged↗
PubMed1990

Intersegmental spinal flexibility with lumbosacral instrumentation. An in vitro biomechanical investigation.

Flexibility of the porcine lumbosacral spine was measured after application of six different types of surgical instrumentation, and in a control state. Fifteen adult pig spines were tested with flexion, extension, lateral bending, and axial rotation torques applied to the upper end with the pelvis fixed. Instrumentation was applied across two lumbar segments and the lumbosacral level (L5-6, L6-7, and L7-S1). Stereophotogrammetry was used to track markers applied to each vertebra. Intersegmental motion was measured as three angles and as the relative linear translation of adjacent transverse processes and spinous processes. Results showed that all instrumentation systems reduced intersegmental motion compared with the control state, except for minimal reduction at L5-6 by Harrington instrumentation in all loading directions, especially axial rotation. The pedicle screw systems were always the most rigid. After applying instrumentation, there were differences in the motion occurring at different anatomic levels, most commonly with the least motion occurring in the middle of the instrumented segment (L6-7). When intervertebral motion was expressed as the linear motion between adjacent spinous and transverse processes, the usual site of posterolateral fusion, it was 0.6 to 1.8 mm per degree of angular motion at the transverse processes and 1.3 to 2.1 mm per degree at spinous processes.

Animals↗
PubMed2005

Image-guided navigation in oral and maxillofacial surgery.

Image-guided surgery is the logical extension of imaging as it integrates previously acquired radiological or nuclear medicine images with the operative field. In conventional image-guided surgery, a surgeon uses a surgical instrument or a pointer to establish correspondence between features in the preoperative images and the surgical scene. This is not ideal because the surgeon has to look away from the operative field to view the data. Augmented reality guidance systems offer a solution to this problem but are limited by deformation of soft tissues. Real-time intraoperative imaging offers a potential solution but is currently only experimental. The additional precision and confidence that this technology provides make it a useful tool, and recent advances in image-guided surgery offer new opportunities in the field of oral and maxillofacial surgery. Here, we review the development, current technologies, and applications of image-guided surgery and illustrate them with two case reports.

Adult↗
PubMed1999

Reversed "C" ministernotomy for aortic valve replacement.

The technique of aortic valve replacement through a reversed "C" sternotomy incision is described. The sternal incision extends between the second and the fifth intercostal space and provides excellent exposure of the ascending aorta, the aortic root, and the right atrial appendage. The procedure can be performed with standard cannulation for cardiopulmonary bypass and conventional surgical instruments.

Heart Valve Prosthesis Implantation↗
PubMed2006

Modelling and evaluation of surgical performance using hidden Markov models.

Minimally invasive surgery has become very widespread in the last ten years. Since surgeons experience difficulties in learning and mastering minimally invasive techniques, the development of training methods is of great importance. While the introduction of virtual reality-based simulators has introduced a new paradigm in surgical training, skill evaluation methods are far from being objective. This paper proposes a method for defining a model of surgical expertise and an objective metric to evaluate performance in laparoscopic surgery. Our approach is based on the processing of kinematic data describing movements of surgical instruments. We use hidden Markov model theory to define an expert model that describes expert surgical gesture. The model is trained on kinematic data related to exercises performed on a surgical simulator by experienced surgeons. Subsequently, we use this expert model as a reference model in the definition of an objective metric to evaluate performance of surgeons with different abilities. Preliminary results show that, using different topologies for the expert model, the method can be efficiently used both for the discrimination between experienced and novice surgeons, and for the quantitative assessment of surgical ability.

Computer Simulation↗
PubMed2000

[Curative laparoscopic surgery for early gastric cancer: eight years experience].

We have applied two different laparoscopic surgical techniques for early gastric cancer and have successfully treated 111 patients since March 1992. The indications are: 1) preoperative diagnosis of mucosal cancer; 2) lesion size of < 25 mm if the protruding type; and 3) lesion size < 15 mm and UI (-) if the depressed type. The first technique is laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 93). The gastric wall around the cancerous lesion is exposed laparoscopically. The abdominal wall and gastric wall in the vicinity of the lesion are pierced using a 12-G sheathed needle. A small metal rod with a fine wire is introduced into the stomach through the outer sheath. By retracting the metal rod, the lesion can be lifted precisely (i.e., lesion-lifting method). Wedge resection at a sufficient distance from the metal rod is carried out using an endoscopic stapler. The second technique is referred to as laparoscopic intragastric mucosal resection (n = 18). Three balloon trocars are placed in the stomach laparoscopically. The stomach is then insufflated with CO2, and surgical instruments are introduced. The mucosal and submucosal layers around the lesion are resected with sufficient surgical margins. The selection of the laparoscopic technique depends on the site of the cancerous lesion. In our series of 111 patients, sufficient horizontal (mean 15 +/- 5 mm and 8 +/- 4 mm, respectively, using the first and second technique) and vertical surgical margins were achieved. There was no mortality and no major complications in patients undergoing either surgical technique. There have been two recurrences, both mucosal lesions found 2 years after the initial surgery, which were successfully treated with gastrectomy and laser irradiation. All patients have survived for 3 to 96 months, and there has been no trocar site recurrence. In conclusion, these laparoscopic procedures are curative and minimally invasive treatments for early gastric cancer.

Gastric Mucosa↗
PubMed1979

[Biomicroscopy of the fundus in retinal detachment surgery (author's transl)].

Biomicroscopy of the fundus during retinal detachment surgery has the same advantages as indirect ophthalmoscopy. In addition to this, it offers three main advantages over indirect ophthalmoscopy: the observation of the fundus, in an optical cross section of the tissues, the high variation of magnification available, and the observation of the fundus without switching off the light of the operating room. Since 1976--biomicroscopy of the fundus during retinal detachment surgery has been easily performed with the surgical mobile slit lamp manufactured by the firm Zeiss. The angle of the surgical slit lamp can be reduced to 5 degrees. The slit lamp can be used either with the Zeiss OPMI 1 operating microscope or with the Zeiss OPMI 6 operating microscope. The microscope, the contact lens and the surgical instrumentation specialy fitted for biomicroscopy of the fundus during retinal detachment surgery are described. The surgical technique is dealt with, pointing out the practical details which allow for overcoming the own difficulties of biomicroscopy of the fundus during surgery.

Fundus Oculi↗
PubMed1991

Preliminary report: endoscopic laser-microsurgical removal of human gallbladder.

An alternative surgical instrumentation and technique to laser laparoscopic cholecystectomy (LLC) with a case report is presented. Thousands of patients have benefited from the conceptual and practical revolution brought about through LLC (i.e., minimal surgical trauma). The minimal invasiveness of this procedure also can help make surgical treatment more acceptable by the public. The instruments and technique presented are redesigns of ones used in laryngology for 30 years. Utilizing them would provide major cost reduction. Most hospitals around the world already have operating microscopes, electrocoagulation equipment, and CO2 lasers. Some of these are underutilized. The presented patient case shows that the procedure can have similar benefits to LLC, in some respects even more. This open endoscopic technique and instrumentation may be suitable to other abdominal or thoracic procedures.

Cholecystectomy↗
PubMed1998

[A micromanipulator for intraoperative vibratory hearing assessment with an implantable hearing aid transducer].

First concepts of implantable hearing aids to be coupled to the ossicular chain are available for patients with combined or sensorineural hearing loss (SNHL). To ensure that hearing can be improved intraoperative coupling of a test transducer to the ossicular chain is mandatory for allowing surgical anatomy to be checked and vibratory hearing tests to be performed. To achieve this, the test transducer has to be held and positioned securely in situ for some minutes, avoiding risks for middle or inner ear structures. This is not possible using conventional surgical instruments. Thus, a micromanipulator to hold the test transducer during intraoperative hearing tests was developed. This surgical device allows the surgeon safe, risk-free, and controlled coupling of the test transducer to the ossicular chain with one axial and three rotational degrees of freedom. With the aid of a conventional ear retractor (2x2 prongs), the manipulator is fixed at the patient's ear. In conjunction with a piezoelectric test transducer, the manipulator was used in nine patients during local anesthesia. The test transducer is part of an electronic hearing implant (Tübingen implant) specifically designed for SNHL that may be coupled to a middle ear ossicle or the perilymph of the cochlea. The micromanipulator was easy to handle. It allowed accurate positioning of the test transducer in the ear and the desired coupling of the transducer's probe tip to the ossicular chain during auditory tests. According to the principles of integrated safety, the intraoperative risk of ossicular or inner ear injuries caused, for instance, by the patient's head movement is minimized. The design of the manipulator system is universal, also allowing its use for other electronic hearing implants or minimal invasive surgery after minor modifications.

Ear Ossicles↗