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At least 955 records · Page 53Linked to original sources
PubMed1992

[Scoliosis and spondylolisthesis in children and adolescents].

The genuine structural scoliosis is characterized by a rotation of the vertebral bodies. Clinically suspect cases require an exact radiographic assessment. Treatment is based on the radiographically found COBB-angle: physiotherapy, brace and different types of surgical instrumentation are the most common therapeutic procedures. Early diagnosis is essential for the final therapeutic result! Spondylolisthesis can only be diagnosed by X-ray. Surgical stabilization is necessary if pain, instability or progressive gliding are found. The extent of surgical procedures depends on the stage of the gliding process. Therefore early diagnosis is desirable.

Adolescent↗
PubMedDate not supplied

Nd:YAG laser procedures in tumor treatment.

Due to the wide variability of tissue interactions and the possibility of specific applications, the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser is the most important surgical laser. With the adequate choice of application mode and relationship between interaction time and power density, it can be used for precise cutting in the contact mode with the bare fiber, with either a wide or small coagulation seam. With a handpiece a precise focal coagulation for preparation and hemostatic purposes is possible, as well as cutting with the focussed noncontact beam where additionally a wide coagulation seam is necessary. Endoscopically guided coagulation, vaporization, and cutting are possible with bare fibers which can be introduced through nearly all endoscopes. With increasing importance, the possibility for wide and homogeneous volume coagulation is used to destroy diseased tissues either by noncontact irradiation or interstitial placement of the fiber. Thus, the field of laser application in tumor therapy ranges from the treatment of superficial tumors to endoscopic tumor ablation, resection of neoplastic tissue in parenchymatous organs, and interstitial thermotherapy with coagulation of deep-seated primary and secondary malignancies. With its different application modes the laser can be used as a surgical instrument or as a central therapeutical method, whereby perfect control of tissue interactions is always possible by using either visual control for superficial and endoscopic procedures or magnetic resonance imaging and color-coded duplex sonography as a control for interstitial procedures. During 12 years of clinical work we have developed several application modes and have proved the Nd:YAG laser to be an effective instrument in tumor therapy.

Air↗
PubMed1977

Evaluation of autosutures in gastrointestinal surgery.

Autosuture surgical instruments were used in over 300 gastrointestinal operations including 60 gastric resections. The technic and its advantages and disadvantages are reviewed, specifically for gastric surgery. Operating time required has been decreased, and results have been good. The instruments have wide application, and their safety has been proved.

Gastrointestinal Diseases↗
PubMed2000

Giant intracranial aneurysm of the anterior communicating artery treated by direct surgical approach. Case report.

We report the singular case of an exceptionally large giant communicating artery aneurysm successfully treated with a direct surgical approach. The clinical presentation was a relatively short history of frontal headache. In the pre- and postcontrast CT scans the lesion mimicked an intracranial tumor. At surgery the intraluminal thrombus was partially removed with an ultrasonic surgical aspirator; the decompression allowed the isolation and subsequent temporary dipping of the tracts A1 and A2 of both the anterior cerebral arteries. It was then possible to complete the thrombectomy and to dip the neck of the aneurysm. The report emphasizes the indispensable role of MRI for the accurate diagnosis of giant intracranial aneurysms and the recent improvement of the surgical results concerning this category of aneurysms (mainly related to the present wider availability of technical surgical instrumentation).

Carotid Arteries↗
PubMed1985

Ultraviolet-laser ablation of skin.

We report on the use of pulsed ultraviolet-laser irradiation at 193 nm from an argon-fluoride laser and at 248 nm from a krypton-fluoride laser to ablate skin. In vitro, both wavelengths performed comparably, removing tissue precisely and cleanly, and leaving minimal thermal damage to the surrounding tissue. In vivo, the 193-nm laser radiation failed to remove tissue after bleeding began. The 248-nm radiation, however, continued to remove tissue despite bleeding and left a clean incision with only minimal thermal damage. The krypton-fluoride excimer laser beam at 248 nm, which should be deliverable through a quartz optical fiber, has great potential as a surgical instrument.

Animals↗
PubMed2006

Mechanical energy from intraocular instruments cause emulsification of silicone oil.

AIM: The complications of intraocular silicone oil include emulsification, which may lead to vision-threatening disorders such as keratopathy, secondary glaucoma and retinopathy. The authors study the effect of mechanical energy from surgical instruments on the emulsification of silicone oil. METHODS: Three different handpieces (phacofragmentation, phacoemulsification, high-speed vitrectomy) were placed at the interface of balanced salt solution and silicone oil (1000 and 5000 cst, 200 fluid; Dow Corning). The phacofragmentation handpiece was evaluated over different ultrasound powers and duration. Emulsification was quantified with phase-contrast microscopy and manual counting of digital photographs by a masked examiner. In addition, phacoemulsification was performed in the anterior chamber of a human ex vivo eye with full-fill silicone oil. RESULTS: Emulsification increases with higher phacofragmentation power and duration and is greater for 1000 cst silicone oil. Emulsification of silicone oil occurs with phacoemulsification and high-speed vitrectomy handpieces. CONCLUSIONS: The energy from surgical handpieces is sufficient to result in silicone oil emulsification.

Emulsions↗
PubMed2005

Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis.

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.

Adult↗
PubMed2002

Coronary revascularization in the 21st century. Emphasis on contributions by Japanese surgeons.

The first three decades of coronary artery surgery have provided the foundation for the next century of this evolution. It is apparent that a multitude of events including the development of cardioplegia, improving surgical instrumentation, technological advances including endoscopic approaches and computer assisted robotics and biologic discoveries such as the role of the endothelium have provided the underpinnings for improved surgical outcomes. However, the single most important determinant of late results is the type of bypass conduit used for grafting. Thus, use of the left internal thoracic artery (ITA) grafted to the left anterior descending coronary is a more important determinant of survival than is any other factor (progression of coronary artery disease, increased age, poor left ventricular function, diabetes, female gender and off-pump operations). Use of two ITAs provides further benefit and it is likely that three or more arterial conduits will be shown to be advantageous in this regard in due time. Japanese cardiothoracic surgeons have made significant contributions to the continuing evolution of coronary bypass surgery and particularly to the advance of arterial conduits. This report will address those contributions to this evolution.

Coronary Artery Bypass↗
PubMed2003

Stress hormones during the wake-up test in scoliosis surgery.

STUDY OBJECTIVE: To compare hemodynamic and endocrine stress responses of two anesthetic regimes during intraoperative wake-up tests in scoliosis surgery. DESIGN: Randomized, controlled clinical study. SETTING: University hospital. PATIENTS: 40 ASA physical status I and II teenage patients scheduled for scoliosis surgery. INTERVENTION: Patients were randomly divided into two groups: the propofol group (Group P) and the sevoflurane group (Group S). In Group P, anesthesia was induced with propofol and remifentanil and was maintained with infusions. Sevoflurane and remifentanil were used in Group S. After surgical instrumentation, patients were awakened, and the wake-up times were recorded. To determine the stress responses, blood samples were taken before induction, 10 minutes after surgical incision, before the wake-up test, during the wake-up test, and 10 minutes after the wake-up test. Cortisol, epinephrine, and norepinephrine concentrations, and hemodynamics all were recorded at the same time. MEASUREMENTS AND MAIN RESULTS: The times from discontinuation of anesthetics to eye opening and movement were similar in both groups. Epinephrine and norepinephrine concentrations during the wake-up test were significantly higher than pretest results in both groups (p < 0.001). There were no statistically significant differences between groups in heart rate or blood pressure. CONCLUSIONS: Propofol-remifentanil anesthesia is equivalent to sevoflurane-remifentanil anesthesia for a wake-up test. Both the propofol- and sevoflurane-based anesthetic regimens abolish hemodynamic and endocrine stress responses to incision for scoliosis surgery in teenagers. Intraoperative wake-up testing is associated with substantial catecholamine stress despite virtually unchanged mean arterial pressure and heart rate.

Adolescent↗
PubMed1975

[The use of laser in thoracic-, cardiac- and vascular surgery (author's transl)].

We carried out thoracic and cardiovascular operations with a 50 watt CO2-Laser. The advantage of this procedure: A minimal trauma of tissue in consequence of no use of selfcutting surgical instruments, bloodless incision at smallest area of coagulation and no possibility of displacement of infections and tumor cells. We believe that this new laser in all surgical disciplines introduced soon.

Aorta↗
PubMed1995

Laser hair transplantation. Tissue effects of laser parameters.

BACKGROUND: Micro- and minigrafting have become increasingly popular in hair transplantation over the past decade, resulting in larger numbers of grafts per session and lengthy, potentially technically difficult procedures. The advent of very high energy pulsed carbon dioxide lasers as surgical instruments has led to the investigation of their use in hair transplantation, as bloodless surgery with tissue removal by vaporization has obvious advantages as far as surgical speed is concerned. METHODS: A prospective study of eight patients comparing conventional micro- and minigrafting using 18- and 14-gauge needle punctures with dilators versus laser-vaporized donor sites with variation of laser parameters was conducted with monthly evaluation of healing and hair growth for 6 months. In addition, an in vitro histological study of laser vaporization recipient sites on excised scalp tissue was conducted to evaluate the residual thermal damage of various laser parameters. RESULTS: The conventional micro- and minigrafts healed faster and resulted in better hair growth than the laser vaporization sites. The donor sites were judged to be comparable as far as healing, but more time consuming with the laser. The operative time for the laser recipient sites was 50% of that of the conventional sites. CONCLUSIONS: The clinical results of laser hair transplantation are very dependent upon the laser parameters and technique used. Though operative time may be significantly reduced, the end result clinically is dependent on proper choices of pulse parameters and technique.

Adult↗
PubMedDate not supplied

[Migration of an intrauterine device. An unusual cause of bladder foreign body].

The origin of vesical and lower urinary tract foreign bodies is very wide, the specialized literature descriptions ranging from urethral dilators to coffee spoons handles through wires, cables and surgical instrumentation. The most frequent entry route of foreign bodies to the lower urinary tract is through the urethra usually by self-introduction or during transurethral surgical procedures. Another access route is that occurring during open or traumatic surgical manoeuvres. Less frequent is that the foreign body migrates from another anatomical structure. These patients present an heterogeneous clinical picture which depends on the location of the foreign body in the urinary tract. Thus, it can be acute if located in the urethra or subacute or chronic if found at vesical level.

Female↗
PubMed1993

Pancreatic cystogastrostomy by combined upper endoscopy and percutaneous transgastric instrumentation.

Minimally invasive endoscopic and radiologic techniques have been reported for internal gastric drainage of pancreatic pseudocysts but these have significant technical limitations. A purely endoscopic approach to cystogastrostomy provides limited access for instrumentation and hemostasis. Radiologically-guided percutaneous techniques cannot regularly provide an adequately wide cystogastrostomy opening. Reported is a patient who had a pancreatic cystogastrostomy performed using a minimally invasive surgical approach combining upper endoscopy and percutaneous transgastric surgical instrumentation. The upper endoscope essentially served as a camera. A percutaneous endoscopic gastrostomy tube served as a port for inserting laparoscopic instruments into the stomach. The laparoscopic instruments were used to create a 1.5 cm cystogastrostomy opening similar in size to what could be created by an open abdominal approach. The laparoscopy instruments provided good tactile feedback and excellent hemostatic control. Avoiding an open abdominal procedure shortened postoperative recovery and reduced patient discomfort. Although the pseudocyst recurred once, the same procedure was performed again and there has not been a recurrence for 10 months. The authors conclude that this minimally invasive surgical procedure provides an excellent alternative approach for internal drainage of selected pancreatic pseudocysts.

Adult↗
PubMed2003

Comparison of laparoscopic skills performance between standard instruments and two surgical robotic systems.

BACKGROUND: Our objective was to compare the performance of laparoscopic tasks by surgeons using standard laparoscopic instruments and two surgical robotic systems. METHODS: Eighteen surgeons performed tasks in a training box using three different instrument systems: standard laparoscopic instruments, the Zeus Robotic Surgical System, and the da Vinci Surgical System. Basic tasks included running a 100-cm rope, placing beads onto pins, and dropping cotton peanuts into cylinders; fine tasks included intracorporeal knot tying and running stitches with 4-0, 6-0, and 7-0 sutures. Time (in seconds) required and precision (number of errors) in performing each task were recorded. Analysis of variance with pair-wise comparisons using the Bonferroni method and Friedman's nonparametric test were used for statistical analysis. RESULTS: Standard instruments performed significantly faster than either robotic system on the rope and bead tasks (p <0.05), whereas da Vinci performed significantly faster than Zeus in all three basic tasks (p <0.05). No significant difference in precision was found between standard instruments and the robotic systems on any of the basic tasks. Knot-tying and running-suture time were similar between standard instruments and da Vinci, which were significantly faster than Zeus (p <0.05) for all suture sizes. The robotic systems were similar in precision for fine suturing tasks and were significantly more precise in knot tying (Zeus and da Vinci) and running sutures (da Vinci) than standard instruments (p <0.05). CONCLUSIONS: Basic laparoscopic task performance is generally faster and as precise using standard instruments compared to either robotic system. In performing fine tasks, neither robotic system is faster than standard instruments, although they may offer some advantage in precision.

Clinical Competence↗
PubMed2006

Clinical and histological healing pattern of peri-implantitis lesions following non-surgical treatment with an Er:YAG laser.

BACKGROUND AND OBJECTIVES: The aim of the present study was to assess clinical and histo-pathological healing pattern of peri-implantitis lesions following non-surgical treatment with an Er:YAG laser (ERL). STUDY DESIGN/MATERIALS AND METHODS: Twelve patients suffering from peri-implantitis (n = 12 implants) received a single episode of non-surgical instrumentation using ERL (12.7 J/cm2). Assessment of clinical parameters (plaque index (PI), bleeding on probing (BOP), probing pocket depth, gingival recession (GR), and clinical attachment level (CAL)), surgical defect examination, and histo-pathological examination of peri-implant tissue biopsies was performed after 1, 3, 6, 9, 12, and 24 months. RESULTS: All patients exhibited improvements of all clinical parameters investigated. However, histo-pathological examination of tissue biopsies revealed a mixed chronic inflammatory cell infiltrate (macrophages, lymphocytes, and plasma cells) which seemed to be encapsulated by deposition of irregular bundles of fibrous connective tissue showing increased proliferation of vascular structures. CONCLUSION: It was concluded that a single course of non-surgical treatment of peri-implantitis using ERL may not be sufficient for the maintenance of failing implants.

Aged↗
PubMed2002

Intraocular and plasma HIV-1 RNA in HIV-infected patients with CMV retinitis and HIV-infected controls.

HIV-1 RNA was quantified in intraocular specimens and plasma from AIDS patients with CMV retinitis undergoing therapeutic vitrectomy and in 8 control subjects undergoing cataract surgery using the Amplicor RT-PCR-based assay. The HIV-1 RNA concentration in the intraocular specimens was significantly lower than in plasma. Patients with CMV retinitis and plasma HIV-1 RNA concentrations > 100,000 copies/ml generally had detectable HIV-1 RNA in their intraocular specimens. These findings point to the risk of percutaneous injury from a sharp instrument used in HIV-infected patients during ophthalmic surgery and possible transmission of HIV during such surgery. Prevention of percutaneous contact will require the use of surgical instruments that reduce the likelihood of injury, as well as the wearing of double gloves during surgery.

AIDS Serodiagnosis↗
PubMed1994

Seventeen level laminectomy for extensive spinal epidural abscess: case report and review.

Several studies have suggested that non-operative treatment be employed for spinal epidural abscesses involving a considerable length of the vertebral column. The reasons for this have not been clearly stated in the literature, however, nor has the critical number of vertebral levels been specified. Presumably, this is related to the morbidity of extensive laminectomy, but we began to question this assumption because of advances in surgical instrumentation combined with frequent reports of irreversible disease progression while on appropriate antibiotics. In this article, we present a case of an extensive spinal epidural abscess managed surgically with no associated morbidity. In addition, we present a review of the literature concerning spinal epidural abscess.

Abscess↗
PubMed1993

The advantages of laparoscopic assisted bipolar high-frequency surgery.

Monopolar and bipolar application techniques of high-frequency surgery are compared concerning safety regulations, functional and energetic aspects and aspects of application. The availability of newly developed bipolar and multipolar surgical instruments for cutting and coagulating without instrument change and at low high-frequency power opens up a new dimension in laparoscopic assisted electrosurgery. The well-known risks of using monopolar instruments in laparoscopy have been eliminated with the new instrumentation presented.

Electric Conductivity↗