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At least 1,009 records · Page 56Linked to original sources
PubMed2003

Cataract surgery in patients with prior refractive surgery.

As the number and types of keratorefractive procedures increase and as the baby boomer population moves into the "cataractous decades," the number of patients requiring cataract surgery following refractive surgery grows larger each year. While technological advances in surgical instrumentation and intraocular lens (IOL) design allow us to perform cleaner, faster, and more reliable cataract extractions, the ultimate postoperative refraction depends primarily on calculations performed before surgery. Third-generation IOL formulas ( Haigis, Hoffer Q, Holladay 2, or SRK/T) provide outstanding accuracy when used for eyes with physiologic, prolate corneas. In addition, most instruments used today for measuring corneal curvature and power were designed before the era of refractive surgery. These formulas and instruments make assumptions about the anatomy and refractive properties of the cornea that are no longer valid following most keratorefractive procedures. These breakdowns in IOL calculation often result in a "refractive surprise" after cataract surgery, which may require subsequent surgical correction. This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting "refractive surprises" postoperatively.

Cataract Extraction↗
PubMed1977

[Surgical interventions in patients with pacemakers].

The increasing rate of pacemaker patient operations is due to the rising number of pacemaker carriers. Preoperative recognition of cardiac dysrhythmia is frequent, so that pacemaker implantation prior to operation is essential for the achievement of the operability. The corresponding control of pacemaker function and the appropriate checking of security precautions permit feasible preoperative preparations as well as operations similar to those in non-pacemaker carriers. Our observations are in agreement with others in the literature that a pacemaker does not increase the operation risk. On the contrary, it often makes operability achievable. A continuous and safe patient control through the new ECG-apparatus is possible, even with use of high frequency surgical instruments.

Age Factors↗
PubMed2000

SonoWand, an ultrasound-based neuronavigation system.

OBJECTIVE: We have integrated a neuronavigation system into an ultrasound scanner and developed a single-rack system that enables the surgeon to perform frameless and armless stereotactic neuronavigation using intraoperative three-dimensional ultrasound data as well as preoperative magnetic resonance or computed tomographic images. The purpose of this article is to describe our two-rack prototype and present the results of our work on image quality enhancement. DESCRIPTION OF INSTRUMENTATION: The system consists of a high-end ultrasound scanner, a modest-cost computer, and an optical positioning/digitizer system. Special technical and clinical efforts have been made to achieve high image quality. A special interface between the ultrasound instrument and the navigation computer ensures rapid transfer of digital three-dimensional data with no loss of image quality. OPERATIVE TECHNIQUE: The positioning system tracks the position and orientation of the patient, the ultrasound probe, the pointer, and various surgical instruments. This makes it possible to update the three-dimensional map during surgery and navigate by ultrasound data in a similar manner as with magnetic resonance data. METHODS: The two-rack prototype has been used for clinical testing since November 1997 at the University Hospital in Trondheim. EXPERIENCE AND RESULTS: The image quality improvements have enabled us, in most cases, to extract information from ultrasound with clinical value similar to that of preoperative magnetic resonance imaging. The overall clinical accuracy of the ultrasound-based navigation system is expected to be comparable to or better than that of a magnetic resonance imaging-based system. CONCLUSION: The SonoWand system enables neuronavigation through direct use of intraoperative three-dimensional ultrasound. Further research will be necessary to explore the potential clinical value and the limitations of this technology.

Equipment Design↗
PubMed2004

Usefulness of the perineum pusher in performing rectal procedures.

We invented the Perineum Pusher to prevent excessive extension of the rectum by elevating the bottom of the pelvis. In the treatment of cancers of the middle and lower thirds of the rectum, a clear operative view can be maintained for a long time by using the Perineum Pusher. Consequently, a sphincter-saving rectal resection with coloanal anastomosis can be performed easily and safely. In addition, intraoperative rectal irrigation can be performed using the Perineum Pusher. No complications resulting from the Perineum Pusher have been experienced in 27 rectal cancer patients. As the Perineum Pusher can be used very simply and effectively in sphincter-saving rectal resections with coloanal anastomosis, this new surgical instrument is therefore highly recommended for use when performing various rectal procedures.

Anastomosis, Surgical↗
PubMed1985

Metroplasty and myomectomy with the CO2 laser for maximizing the preservation of normal tissue and minimizing blood loss.

A study was designed to evaluate the efficacy of the CO2 laser in performing conservative uterine surgery, metroplasty and myomectomy; to determine blood loss using this technique; and to ascertain how much normal uterine tissue was preserved. To assess the effectiveness of this new surgical technique, 22 patients underwent metroplasty, myomectomy or both utilizing the CO2 laser. The blood loss via microlaser surgery was compared to that in a group of 14 patients who underwent conventional surgery. The initial findings indicated that the CO2 laser is a viable surgical instrument for myomectomy and metroplasty and that its use yields less blood loss and greater preservation of normal tissue.

Adult↗
PubMed2004

Transparent microballoon dissection in the surgical treatment of brain tumors.

In spite of maximal microsurgical efforts, perilesional neural tissue can be injured by surgical instruments in the process of the separation and dissection of tumors. We hypothesized that transparent microballoon dissection could be helpful in the gentle separation of brain tissue from tumor by minimizing cerebral damage, and in separating sulcal and cisternal walls during surgical interventions on brain masses. We used the transparent microballoon dissection technique in 3 primary cases and 4 metastatic brain tumors that were verified with computed tomography (CT) and magnetic resonance imaging (MRI). Gentle separation of tumor from surrounding brain, reduction of cerebral damage, and separation of sulcal and cisternal walls were feasible in all patients. Postoperative CT and MRI showed satisfactory results in reducing perilesional cerebral damage. The transparent microballoon inflation technique is a useful microsurgical method for the gentle separation of tumors from surrounding brain tissue, minimizing cerebral damage, and separating sulcal and cisternal walls during surgical interventions for brain masses. Our conclusion is that using the microballoon dissection method may be suitable in microneurosurgical practice.

Adult↗
PubMed1982

Arthroscopic treatment of the discoid lateral meniscus. Technique and long-term results.

Forty-five patients (49 knees) who had torn complete or incomplete discoid lateral menisci were treated during the period from 1968 to 1980. Both instrumentation and specific techniques considerably evolved in the arthroscopic complete excision the torn discoid meniscus. The current technique involves the initial removal of the anterior portion of the meniscus, as this allows clearer visualization during the procedure, more space for manipulating surgical instruments, and a reduced operative time. Twenty-four knees (22 patients) were followed for a mean of four years three months. Of this group, 78% were rated excellent or good and 21% were rated fair. There were no poor results. The results in the group treated by total meniscectomy were better than those in the group treated with partial meniscectomy. Three patients were treated by peripheral meniscal repair under arthroscopic control, but the long-term results are not available.

Adolescent↗
PubMed2005

3-Tesla intraoperative MR imaging for neurosurgery.

Intraoperative magnetic resonance (MR) image-guided neurosurgery has been performed since 1994. Using a 1.5-Tesla (T) intraoperative MR imaging system, we have performed more than 750 interventional procedures. Having validated the safety and efficacy of this surgical technique that is relatively amenable to nearly all new in-hospital MR suites, we sought to adapt this approach at our sister hospital where a new short-bore 3-T MR suite was being installed. Using many of the lessons learned from our initial experience at 1.5-T, we designed a new interventional suite that would enable surgery to be performed entirely within a 3-T MR environment. All surgical instrumentation including electrocautery, fiberoptic headlamp, power drill, and ultrasonic aspirator was entirely MR-compatible. A few items with limited ferromagnetism were utilized within the magnetic field under strict precaution. From 2/04 to 7/05, those cases initially performed within the 3-T surgical suite included one drainage and reservoir placement for a cystic craniopharyngioma, five brain biopsies and two craniotomies; one for open brain biopsy and another for lesion resection. The craniopharyngioma was successfully aspirated and had the reservoir catheter placed within the cyst. All five brain biopsies yielded diagnostic tissue. The craniotomy for mass resection demonstrated radiation necrosis. Although the metallic artifact from the biopsy needle was more prominent than at 1.5-T, accurate image interpretation was possible. Surgical needles, disposable scalpel, disposable razor, and surgical stapler were minimally ferromagnetic and safely controlled by the surgeon. There were no adverse events associated with any procedure. MR-guided neurosurgery can be safely and effectively performed at 3-T. The surgical environment at 3-T is comparable to that present at 1.5-T.

Adult↗
PubMed2001

Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery.

OBJECTIVE: Well-established surgical goals for pituitary macroadenomas include gross total resection for noninvasive tumors and debulking with optic chiasm decompression for invasive tumors. In this report, we examine the safety, reliability, and outcome of intraoperative magnetic resonance imaging (iMRI) used to assess the extent of resection, and thus the achievement of preoperative surgical goals, during transsphenoidal microneurosurgery. METHODS: Our magnetic resonance operating room contains a Hitachi AIRIS II 0.3-T, vertical-field open magnet (Hitachi Medical Systems America, Inc., Twinsburg, OH). A motorized scanner tabletop moves the patient between the imaging and operative positions. For transsphenoidal surgery, the patient is positioned directly on the scanner tabletop so that the surgical field is located between 1.2 and 1.6 m from the magnet isocenter. At this location, the magnetic field strength is low (<20 G), thus permitting the use of many conventional surgical instruments. Thirty consecutive patients with pituitary macroadenomas underwent tumor resection in our magnetic resonance operating room by use of a standard transsphenoidal approach. After initial resection, the patient was advanced into the scanner for imaging. If residual tumor was demonstrated and deemed surgically accessible, the patient underwent immediate re-exploration. RESULTS: iMRI was performed successfully in all 30 patients. In one patient, iMRI was used to clarify the significance of hemorrhage from the sellar region and resulted in immediate conversion of the procedure to a craniotomy. In the remaining 29 patients, initial iMRI demonstrated that the endpoint for extent of resection had been achieved in only 10 patients (34%) after an initial resection attempt, whereas 19 patients (66%) still had unacceptable residual tumor. All 19 of these latter patients underwent re-exploration. Ultimately, re-exploration resulted in the achievement of the planned endpoint for extent of resection in all of the 29 completed transsphenoidal explorations. Operative time was extended in all cases by at least 20 minutes. CONCLUSION: iMRI can be used to safely, reliably, and objectively assess the extent of resection of pituitary macroadenomas during the transsphenoidal approach. The surgeon is frequently surprised by the extent of residual tumor after an initial resection attempt and finds the intraoperative images useful for guiding further resection.

Adenoma↗
PubMed2004

The circular stapling device as a risk factor for anastomotic leakage.

AIM: To investigate the relation between the type of circular stapler and anastomotic leak in rectal cancer surgery. BACKGROUND: During the past decades results from rectal cancer surgery have improved considerably regarding risk of local recurrence and survival. Two main paradigm changes are considered to be the cause for this: the introduction of total mesorectal excision (TME) and the increasing use of radiotherapy. However, rectal cancer surgery is associated with an unacceptably high frequency of complications of which anastomotic leak is one of the most severe ones. The hypothesis was raised that the choice of stapler influenced the leakage rates. METHODS: A questionnaire was sent to all departments of surgery (n = 66) performing rectal cancer surgery in Sweden to determine the choice of circular stapler when performing anterior resection for rectal cancer. These data were linked to the Swedish Rectal Cancer Registry for the period 1995-99. RESULTS: A total of 3316 patients had an anterior resection. The choice of circular stapling device was determined in 70% of the cases. When stapler A was used, the leakage rate was 11% whereas it was 7% when stapler B was used (P = 0.0039). In the cases where it was impossible to determine which stapler had been used the leakage rate was 8%. CONCLUSION: Quality control is an important part of medicine and the present study suggests that it also must include surgical instruments. A prospective randomised study is needed to confirm the results.

Adult↗
PubMed1997

Subretinal microsurgery with gradient index endoscopes.

State-of-the-art subretinal surgery involves a standard three-port pars plana entry, followed by an iatrogenic retinotomy to access the subretinal space. Subretinal manipulations through a small retinotomy are made possible by specially designed instruments. As the surgeon looks through the vitreous cavity, all subretinal maneuvers are obscured by the overlying retina. Consequently, the surgeon is operating 'blindly' and has to rely on 'feeling' rather than direct visualization. Micro-endoscopic viewing systems are the ideal solution for visualization during subretinal surgery. Until now, such endoscopes were either too large for intraocular use or lacked sufficient resolution, especially at a short working distance. Recently, a gradient index (GRIN) endoscope was developed (Insight Instruments, Inc., Lake Mary, Fla., USA) combining a small diameter (0.89 mm, 20 gauge) and incorporating excellent optical resolution, even at extremely close working distances. After ballooning a limited part of the retina without creating a retinal hole, the 20-gauge GRIN endoscope can be introduced into the subretinal space through the sclera and choroid, posterior to the pars plana. Surgical instruments can then be introduced into the subretinal space through a second neighboring sclerotomy. Thus, subretinal surgery can be performed under direct endoscopic control. As a result of direct visualization, the surgeon may perform certain surgical procedures with greater accuracy, i.e., subretinal neovascular membranes may be dissected meticulously from the neurosensory retina and retinal pigment epithelium, minimizing damage to both structures. The feeding choroidal vessel can be identified and directly coagulated, which is usually very difficult during conventional subretinal surgery. Endoscopic subretinal surgery is thus a significant improvement over conventional methods, avoiding the need for a retinotomy and increasing the safety and facility of the surgery itself.

Endoscopy↗
PubMed2003

[Influence of an Er:YAG laser on the surface structure of titanium implants].

In addition to conventional treatment modalities (mechanical and chemical), the use of lasers has been proposed for cleaning and detoxification of implant surfaces. The aim of the present clinical investigation was (1) to evaluate the effects of an Er:YAG laser on the surface properties of titanium implants in vivo and (2) to determine the effectiveness of this treatment modality for subgingival calculus removal. This investigation was conducted on eight implants of two patients, considered for explantation due to severe peri-implantitis inflammation. Immediately before explanatation, six implants were instrumented subgingivally with an Er:YAG laser (100 mJ/pulse and 10 Hz). Two implants served as a control. All titanium implants were examined using scanning electron microscopy by one calibrated and blinded examiner. In comparison to the untreated control group, non-surgical instrumentation of titanium implants with an Er:YAG laser resulted in an effective removal of subgingival calculus without leading to any thermal damages. However, all samples of the test group revealed amounts of residual debris which should be taken into account under clinical conditions.

Decontamination↗
PubMed2006

[Effects of medical robot-assisted surgical navigation system in distal locking of femoral intramedullary nails: an experimental study].

OBJECTIVE: To investigate the effects of medical robot-assisted surgical navigation system based on fluoroscopic images in distal locking of femoral intramedullary nails. METHODS: Using a robot-assisted computer-guided system designed based on modularization and minimization that permitted C-arm alignment assistance and real-time navigation control, provided constant feedback without the need for radiologic updates, thus avoiding constant X-ray exposure. The C-arm was used to collect the orthotopic and lateral X-ray images into the computer so as to calculate the locations of the target points. Nails were locked into 5 plastic femurs (Swiss Sybone, 35 holes), 2 dry human femoral specimens (12 holes), and one leg of fresh human cadaver (6 holes). Radiographs were taken to confirm that screws were positioned correctly, and fluoroscopic time associated with the locking procedure was recorded. RESULTS: All distal holes were locked successfully. In 6 (11.1%) of the 53 holes the drill bit touched the canal of the locking hole, albeit with no damage to the nail. The fluoroscopy time of per screw was 1.83 +/- 0.31 seconds. CONCLUSION: The medical robot-assisted surgical navigation system enables the physicians to precisely navigate surgical instruments throughout the procedure using just a few computer-calibrated radiographic images. The total radiation time per procedure can be significantly reduced because additional X-ray exposure is not required for tool navigation. The idea of a robot-assisted surgical navigation system is practicable.

Bone Nails↗
PubMed1992

[Perforation of surgical gloves in gynecologic operations and abdominal Cesarean section].

The aim of the study was to determine the incidence of glove perforation during gynaecological operations and Caesarean section, and to assess the value of double gloving. For this purpose the surgical gloves used in 415 procedures were tested for perforations by the water leak test. For laparotomy and breast surgery, two pairs of gloves (brand A) were worn; for vaginal and other surgery, only a single pair of thicker gloves (brand B) was used. As controls, 75 pairs of unused gloves of each brand were tested. This revealed 6 (4%) perforations in brand A gloves and 2 (1.3%) perforations in brand B gloves. Most perforations (20-40%) occurred during hysterectomy, Caesarean section, and other types of laparotomy. The gloves worn by the scrub nurse or technician were most often perforated (43.5% after vaginal hysterectomy), followed by the surgeon's gloves (29% after laparotomy). Perforations were most often located at the tip of the index finger (16.8%) and thumb (16.2%) of the nondominant hand. If two pairs of gloves were worn, and perforation occurred, only 26.7% had perforations at identical sites on the outer and inner gloves. Consequently, since three quarters of the perforations were limited to the outer glove, double gloving reduced the risk of exposure to blood by a factor of 4. The results of this study support the recommendation that two pairs of gloves be worn, at least during major surgical procedures and Caesarean section. Furthermore, the alternative operative techniques and methods of handling surgical instruments proposed for reducing the incidence of glove perforation should be tested.

Cesarean Section↗
PubMed1996

In minimal access surgery.

The pediatrician must be cognizant of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide either outpatient surgery or short-stay surgery appears to be cost-effective and appropriate state-of-the-art medical care. As the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will become increasingly available.

Age Factors↗