Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Surgical Instruments”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMedDate not supplied

Costs and benefits of laparoscopic cholecystectomy: abdominal wall lifting vs. pneumoperitoneum procedure.

BACKGROUND/AIMS: Gasless laparoscopic surgery using the abdominal wall lifting (AWL) method was first developed in Japan and has been used in various surgical fields. The AWL method allows the use of conventional reusable surgical instruments. The purpose of this study was to compare the cost-effectiveness of laparoscopic cholecystectomy (LSC) using the AWL method in relation to that using pneumoperitoneum (P) method. METHODOLOGY: Retrospective analysis of 431 LSC procedures between 1991 and 2004 was performed. The two surgical groups consisted of consecutively operated patients with a diagnosis of cholecystolithiasis or gallbladder polyps. One group consisted of 224 LSC procedures performed using the P method from 1992 to 1998 and the other group comprised 207 LSC performed using the AWL method from 1998 to 2004. All instruments used in the P method were disposable, whereas trocars, scissors, dissectors, graspers and L-hook electrodes (excluding clips) used in the AWL method were reusable. Hospital expenses, length of hospital admission and complication rates were analyzed. RESULTS: Mean hospital cost per case for LSC using the AWL method (dollars 6743) was 7% less expensive than that using the P method (dolars 7215). Costs of operative equipment contributed to the difference (mean dollars 912 per case) in total cost. Conversion to open cholecystectomy occurred in 6 cases (2.9%) using the AWL method and 7 cases (3.1%) using the P method. There were no significant differences in length of hospital admission or complication rates between the two groups. CONCLUSIONS: LSC using AWL method was less expensive than that using P method. This is mainly due to the use of reusable instruments in the AWL method. If LSC is performed using the AWL method instead of using disposable equipment, considerable savings can be achieved without compromising patient safety.

Abdominal Wall↗
PubMed2004

A novel technique of finger-assisted laparoscopic surgery.

BACKGROUND: Although advanced and complex laparoscopic procedures are now being performed, tactile sensation is limited with available laparoscopic instrumentation. For immediate hemostasis, it sometimes is necessary to convert laparoscopic into open surgery. METHODS: We improved the procedure with the aid of an abdominal wall sealing device, a Lap protector, and a surgical grove. With this simple apparatus, we can easily switch from laparoscopic to open surgery and vice versa. RESULTS: Only 4 cm of skin incision was made. The operator can use his or her finger and most of the usual surgical instruments during the laparoscopic surgery. CONCLUSIONS: Finger-assisted laparoscopic surgery is affordable to perform the advanced laparoscopic procedure. This new technique made laparoscopic abdominal surgery easier and safer for beginners in laparoscopic surgery and skilled surgeons in open surgery. For the experts, this technique set up the safety door for the emergency in laparoscopic surgery.

Aged↗
PubMed1996

Instrumentation of the patellar osteotomy in total knee arthroplasty. The relationship of patellar thickness and lateral retinacular release.

This study investigates the influence of patellar thickness in total knee arthroplasty (TKA) with routine patellar resurfacing on the rate of lateral retinacular release. A study group comprised of 121 TKAs using surgical instrumentation allowing a measured resection of the patella was compared with a control group comprised of 100 TKAs using an "eye-ball" technique for patellar resurfacing without particular attention to patellar thickness. A composite without patellar thickness equal to or slightly less than the original patella was attempted in the study group. The average thickness difference of the patella in the study group was -1.58 mm. Lateral retinacular release for patellar maltracking was performed in 12.4% of knees in the study group compared with 55% of knees in the control group. The variation in patellar thickness in this series often led to a residual bone thickness < 15 mm. No clinical problems have been observed to date.

Aged↗
PubMed1998

[Discrepancy between surgeon's binocular parallax perception and manipulation in the neurosurgical operation].

The application of virtual reality (VR) to the neurosurgical field has been increasing recently, however, the relation between the surgeon and the VR environment is rarely studied. We examined the trajectory of a surgical instrument during manipulation of a virtual object using a video-see-through microscope and a neurosurgical navigator (CANS Navigator) to find better surgeon-microscope interface. A resin cylindrical phantom was produced representing the surgical field, which included two 3 dimensionally arranged small spheres and a virtual 'gate'. The phantom was fixed and set under the microscope with a skull clamp mimicking conditions in an ordinary craniotomy. Firstly, the binocular parallax perception under microscope was examined. Experienced and inexperienced neurosurgeons were asked to learn the position of the virtual 'gate' for 3 minutes. Then, after 5 minutes to point with the navigator probe (suction tube), under various conditions; under the naked eyes, under the microscope, under the navigator without observing the phantom, and under the microscope with picture in picture (PIP) display of the navigational image. The positions of the suction tube were recorded at real time into the navigator for later analysis. Secondly, the task performance in this VR environment was studied by analyzing the trajectory of the suction tube from one sphere to the other sphere passing the virtual 'gate' under various conditions. A significant difference in pointing precision between experienced and inexperienced neurosurgeons was able to be observed only under microscope. This difference was mainly derived from overestimation of the depth of the virtual 'gate' by the inexperienced neurosurgeons. Among the above conditions, pointing under the microscope with PIP was able to be performed the most precisely and the most promptly. This study disclosed the presence of stereoscopic distortion in the microscope. The PIP display of the navigational image in the microscopic view remarkably improved the task performance, which could be accounted for by the correction of the somewhat distorted binocular parallax perception under the neurosurgical microscope by the provision of another visual key.

Brain↗
PubMed1994

Morbidity from anterior ilium bone harvest. A comparative study of lateral versus medial surgical approach.

The morbidity of bone harvest was compared between anterior lateral and medial surgical approaches in a randomized prospective study. Forty consecutive patients, each requiring a minimum 40 cc of loose corticocancellous bone for maxillofacial reconstruction, were randomly placed into two equal groups. Morbidity vectors assessed included bone volume, blood loss, length of surgery, length of hospital stay, incidence of seroma, incidence of anterior thigh paresthesia, postoperative pain, and gait disturbance. The results demonstrated no significant difference in morbidity between these two approaches; therefore selection of either approach is the surgeon's personal preference. A thorough understanding of the osseous anatomy of the anterior ilium and its muscular attachments, a good surgical technique, an efficient surgical team, and a continuous flow of required surgical instruments are essential to reduce the morbidity of bone harvest.

Adult↗
PubMedDate not supplied

[Effect of storage time on sterility of instrument in oral surgical packs].

The study was carried out to test the effect of storage time on sterility of instruments in oral surgical packs used in the out patient unit, Dental Hospital, Prince of Songkhla University. Stainless steel wire was used to represent the instruments and put in each pack of all 705 oral surgical packs. After autoclaving at the different storage times within a period of three months, no contamination was found. Therefore, it could be concluded that the sterilization and storage methods of oral surgical packs in the Dental Hospital are acceptable.

Dental Instruments↗
PubMed1998

A minimally invasive technique of appendectomy using a minimal skin incision and laparoscopic instruments.

To take advantage of the laparoscopic procedure, a new minimally invasive technique of appendectomy for nonobese and uncomplicated appendicitis is presented. Initially, diagnostic laparoscopy is performed through a minimal skin incision (microceliotomy) 1.5-2.0 cm in length in the right lower abdomen to rule out other disease. Then an appendectomy is performed using conventional surgical instruments under direct vision through the previous skin incision. There were 18 women and 12 men in this series. The mean age was 22.6 years. Pathologic findings of the appendix were: 2 normal, 13 catarrhal, 10 suppurative, and 5 gangrenous type. The mean operation time was 30.7 min. The mean frequency of postoperative analgesic requirement (nalbuphine 0.2 mg/kg) was 0.9 times. The mean hospital stay was 4.1 days (range, 2-7 days), and the duration until return to full activity was 7.6 days (range, 5-14 days). There was no mortality or morbidity. This appendectomy technique is a useful method for minimizing the postoperative pain and operative scar, thus allowing the patient an early return to full activity.

Activities of Daily Living↗
PubMed1991

New technology for sterilization and disinfection.

Sterilization with low temperature steam and formaldehyde is a well-known process in many European countries, but little known in the United States. It sterilizes reliably and reproducibly at temperatures greater than or equal to 65 degrees C. With a well-designed cycle, it leaves residues of formaldehyde on sterilized items below 5 micrograms/cm2, measured on a standard filter paper. Formaldehyde levels in air near the autoclave are well below official exposure limits, if at all measurable. Occurrence of late growers in bioindicators, and penetration of the sterilizing media into long narrow lumina, should be validated for new processes. Automated cleaning and disinfection in closed washer-disinfectors and flushing disinfectors are likewise processes relatively little known in the United States. Disinfection is achieved by a final rinse with hot water or steam. Washer-disinfectors are used for surgical instruments, nondisposable anesthesia and other equipment, flushing disinfectors for nondisposable bedpans, wash-bowls, urinals, and similar equipment. They clean well, washer-disinfectors excellently so, and disinfect reliably. With the use of such equipment in wards, surgical departments, and other areas, reliance on chemical germicides can be dramatically reduced and disposables can be replaced by disinfectable nondisposables.

Disinfection↗
PubMed2001

Transnasal endoscopic management of frontal mucoceles.

Traditional teaching has emphasized the need for complete removal of sinus mucocele to achieve a cure. With the introduction of endoscopic sinus surgical instruments and techniques, however, there has been a trend toward transnasal endoscopic management of frontal mucoceles with recurrence rates at or close to 0%. This article presents a useful classification of frontal mucoceles and the transnasal endoscopic surgical technique.

Frontal Sinus↗
PubMed2002

Early experience of endoscopy-assisted anterior spinal surgery.

PURPOSE: Endoscopy-assisted anterior spinal surgery is less invasive, resulting in less tissue trauma. It has a shorter recovery period, leads to less morbidity, and is more cost efficient than conventional surgery. We report our early experience of endoscopic anterior spinal surgery in Thailand, which was performed with a basic laparoscopic instrument set and self-developed instruments for spinal surgery. METHODS: All patients who underwent endoscopic anterior spinal surgery from July 2000 to May 2001 at the Orthopaedic Department, Nakhonpathom Hospital, Nakhonpathom were prospectively documented. The two-portal technique was applied on these patients: the first portal, a 4-cm skin incision, was made as the portal for the surgical instruments; the second portal, a one-cm skin incision, was made as the portal for the endoscope. RESULTS: Nine patients underwent anterior spinal surgery with the minimally invasive technique. The mean patient age was 51.5 years (range, 17-72 years); 3 patients were females and 6 were males. The procedures included thoracoscopy, retroperitoneoscopy, diaphragmatic crus detachment, discectomy, corpectomy, fusion, and instrumentation. The mean operating time was one hour 58 minutes, and the mean estimated blood loss was 372 ml; there were no serious complications. CONCLUSION: Endoscopy-assisted anterior spinal surgery can be performed without spending a high budget; the procedure is not difficult if the surgeon can develop some instruments and has experiences with arthroscopic surgery and anterior spinal surgery.

Adolescent↗
PubMed2000

Pre-, intra-, and postoperative three-dimensional evaluation of adolescent idiopathic scoliosis.

The authors measured and compared the pre-, intra-, and postoperative three-dimensional shape of the spine during corrective surgery to quantify the specific contribution of positioning, anesthesia, surgical exposure, surgical instrumentation, and postural adaptation of the thoracic and lumbar spine. In 58 adolescent girls with idiopathic scoliosis undergoing corrective surgery by a posterior approach, the three-dimensional geometry of the thoracic and lumbar spine was documented in the standing position before and after surgery using a three-dimensional reconstruction technique based on multiplanar radiography, and the intraoperative three-dimensional geometry was measured using a three-dimensional magnetic digitizer before and after installation of the first rod. Prone positioning, anesthesia, and surgical exposure are responsible for a considerable decrease in all curves in the frontal and sagittal plane. Instrumentation with the first rod produces additional substantial and favorable three-dimensional changes with partial restoration of the normal sagittal curves and sagittal shift of the plane of maximum deformity. Although no loss of correction was observed in the frontal plane when patients resumed their standing position, a "spring-back" effect on the spine was noted in the sagittal plane and a loss of three-dimensional correction was seen in the orientation of the plane of maximum deformity. Surgeons can use the knowledge of these various changes to achieve better results by more careful attention to the preoperative positioning of patients and to curve correction in the sagittal plane when instrumentation is applied to the spine.

Adolescent↗
PubMed1995

Reversible anterior cord syndrome due to penetration of the spinal canal by pedicular screws.

The use of transpedicular screws in patients with disturbed posterior column anatomy is sometimes hazardous. We report a patient with a burst fracture at T7 who developed an anterior cord syndrome immediately after posterior instrumentation. Diagnosis of the anterior cord syndrome was ascertained by an emergency computerised tomogram which showed a misplaced screw compressing the cord from the anterolateral aspect of the spinal canal. Extraction of this screw and revision of the instrumentation resulted in speedy and complete resolution of the neurological deficit. The patient was mobilised within the first postoperative week and was able to work by the fourth postoperative month. The application of smooth contoured screws and blunt surgical instruments was found to be helpful because they are less likely to produce a cutting injury of neural tissue. We must further stress that transpedicular screws for the upper thoracic segments are to be employed very cautiously, if ever, to avoid severe neurological complications.

Adult↗
PubMed2003

Pseudomonas surgical-site infections linked to a healthcare worker with onychomycosis.

OBJECTIVE: To determine the etiology of Pseudomonas aeruginosa surgical-site infections following cardiac surgery. SETTING: University teaching hospital. PATIENTS: Those with wound cultures that grew P. aeruginosa after cardiac surgery performed from 1999 to 2001. METHODS: Medical records and operating room (OR) records of patients with P. aeruginosa cardiac surgical-site infections from 1999 to 2001 were reviewed. Healthcare workers involved with two or more cases were interviewed and examined. Specimens for environmental cultures were obtained from the ORs and cardiac surgical equipment. Cardiac surgery cases were observed and postoperative care and the cleaning of surgical instruments were investigated. OR air handling system records during the epidemic period were reviewed. Molecular fingerprinting of available P. aeruginosa isolates from infected patients and a healthcare worker was done. RESULTS: There were five P. aeruginosa cardiac surgical-site infections from January to August 2001, compared with no such infections from 1999 to 2000. All were adult patients. One cardiac surgeon with onychomycosis operated on all five cases. He did not routinely double glove. The involved fingernail grew P. aeruginosa. Three P. aeruginosa patient isolates were available for pulsed-field gel electrophoresis; two were identical to the isolate from the involved surgeon's onychomycotic nail. No environmental OR cultures grew P. aeruginosa. The surgeon's culture-positive nail was completely removed. There have been no P. aeruginosa surgical-site infections among cardiac surgery patients since this intervention. CONCLUSION: At least two cases of a cluster of P. aeruginosa surgical-site infections resulted from colonization of a cardiac surgeon's onychomycotic nail.

Cardiac Surgical Procedures↗
PubMed2005

Skull base approaches to the basilar artery.

Posterior circulation lesions constitute approximately 10% of all intracranial aneurysms. Their distribution includes the basilar artery (BA) bifurcation, superior cerebellar artery, posterior inferior cerebellar artery, and anterior inferior cerebellar artery. The specific features of a patient's aneurysm and superb anatomical knowledge help the surgeon to choose the most appropriate approach and to tailor it to the patient's situation. The main principle that must be applied is maximization of bone resection. This allows the surgeon to work within a wider corridor, which facilitates the use of surgical instruments and minimizes retraction of the brain. The management of aneurysms within the posterior circulation requires expertise in skull base and vascular surgery. Endovascular treatments have become increasingly important, but in this paper the authors focus on the surgical management of these difficult aneurysms. The paper is divided into three parts: the first section is a brief review of the anatomy of the BA; the second part is a review of the techniques associated with the management of posterior fossa aneurysms; and in the third section the authors describe the different approaches, their nuances and indications based on the location of the aneurysm, and its relationship to the surrounding bone (especially the clivus, dorsum sellae, and the free edge of the petrous apex).

Basilar Artery↗
PubMed2000

Stereotactic surgery: what is past is prologue.

Two old and simple simple concepts, a three-dimensional positioning stage and a coordinate system, were combined in 1906 to create a new one: the stereotactic method. For 25 years, it found little application until it was rediscovered for investigations in small animals. After the first human subcortical stereotactic procedure was performed in 1947, stereotactic methods found greatest application in the placement of subcortical lesions in the treatment of movement disorders. Rapid advances in the development of instrumentation, methods, and understanding of human neuroanatomy and neurophysiology resulted. However, a dormant period followed the introduction of L-dopa in 1968. The advent of computer-based medical imaging applied to the stereotactic method encouraged adaptation of stereotactic methods to the management of intracranial tumors, the rapid development of new surgical hardware, and the rediscovery of old methods and evolution of new ones for the treatment of movement disorders. In addition, the incorporation of computer systems as stereotactic surgical instruments further increased the capabilities of stereotactic methods. Radiosurgical applications increased with the proliferation of gamma units and the development of linear accelerator-based radiosurgical methods. Computers are used to fuse and reformat imaging databases for surgical planning, simulation, and frameless stereotactic intraoperative guidance. As a result, surgical procedures have become more effective in meeting preoperative goals and less invasive. Low-cost, high-speed, microprocessor-based workstation computers and intuitive user interfaces have increased the acceptance into mainstream neurosurgery. It is anticipated that a significant portion of neurosurgery, and probably most surgical procedures in general, will comprise computer-based interventions guided by volumetric imaging-defined data sets acquired preoperatively or by intraoperative imaging systems. The stereotactic surgery of the future may employ all or a combination of the following technologies: frameless stereotactic surgery, robotic technology, microrobotic dexterity enhancement, and telepresence robotics.

Brain↗
PubMed2001

Registration in interventional procedures with optical navigator.

Performing interventional procedures in the close proximity to an MR scanner widens the range of operations available for an optical tracking system. In order to gain the full benefits from both unrestricted use of surgical instruments outside the magnet and intraoperative imaging, a method for transferring the registration data of the optical navigator between two locations is required. An optical tracking system, which provides such a transfer method and tracks patient position during a surgical procedure, has been developed, tested, and demonstrated with two patient cases. J. Magn. Reson. Imaging 2001;13:93-98.

Adult↗
PubMed1998

An algorithm for selection of instrumentation levels in scoliosis.

Appropriate levels for instrumentation and fusion in scoliosis have been a matter of debate among surgeons since the introduction of operative management of this deformity. We set out to examine the hypothesis that the amount of correction achieved in all planes during surgical instrumentation of a curve should be less than, or comparable to, the degree of correction attainable at any non-instrumented adjacent curve. An algorithm was designed to facilitate preoperative planning and intraoperative performance of spinal fusion procedures in the management of scoliosis. To test the validity of the hypothesis and the proposed algorithm, measurements were taken from the preoperative radiographs of 200 patients. The dimensions of the curves were obtained from an initial set of four X-ray films: (1) standing anteroposterior film of the whole spine, (2) standing lateral film of the whole spine, (3) two properly performed side-bending films including each curve of the spine. With this data, a plan was designed using the algorithm. The results of this plan were compared with the actual results of the surgery, which were revealed only at this stage. All patients in whom actual instrumentation levels fell within those predicted by the proposed algorithm had no imbalance at follow-up. All patients whose actual instrumentation levels were short of those recommended by the algorithm showed obvious imbalance on final postoperative standing radiograph.

Adolescent↗