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At least 1,045 records · Page 58Linked to original sources
PubMed2005

The impact of image-guidance systems on sinus surgery.

Endoscopic treatment of diseases of the paranasal sinuses provides excellent visualization for minimally invasive surgery, and has evolved into a high-volume procedure with documented navigational risks to surrounding vital structures. Image-guidance systems use the data acquired during CT studies of the sinuses, which is processed through a workstation. Following a registration procedure, the coordinates of the tip of the surgical instrument being used are tracked and displayed in three views. The surgeon is then able to monitor the endoscopic work being done in the operative field and simultaneously document the precise location of the tip of the tracked instrument. Ideally, these systems will allow surgeons to accurately perform surgery with increased safety and improve long-term outcomes. Although the accuracies of these systems have been studied and reported [23,37], further large studies are needed to prove or disprove the impact of navigational systems on reducing surgical risk and improving surgical outcomes.Image-guidance systems employing optical and electromagnetic technologies have been clinically available for nearly 10 years, available during a time when there is an increased awareness of the risks of medical treatment and an emphasis on reducing errors. There is a need to prove that this technology, despite its added costs [39], ultimately improves safety and lowers the surgical risk of endoscopic sinus surgery. Only at that juncture can a mandate be made for including these systems in all procedures. There is universal agreement, however, that the use of this equipment can never bea substitute for surgical skill, training, or judgment.

Endoscopy↗
PubMed1991

[Transanal microsurgery].

The system for TEM consists of a rectoscope of 40 mm diameter, stereoscopic optics and up to four surgical instruments for simultaneous application. Operation is performed under automatic gas distension. Since 1983 we have operated upon 332 patients, 280 of whom were analyzed in a prospective clinical trial. The complication rate was below 10%, mortality 0.3% and the recurrence rate ot the adenomas 4%. Compared to the conventional surgical procedures, postoperative pain is significantly lower and hospital stay and rehabilitation time are shorter.

Equipment Design↗
PubMed1996

Balloon mitral commissurotomy: an intraoperative assessment.

OBJECTIVE: Advances in balloon catheter technology have revolutionized the management of obstructive cardiovascular diseases. For lesions like mitral stenosis, balloon commissurotomy has emerged as an alternative to surgical relief showing definite functional benefits in a few clinical trials, albeit with variable results. Such variability necessitated objective evaluation of the efficacy of balloon mitral commissurotomy. METHODS: The balloon mitral commissurotomy was carried out in 11 patients suffering from isolated mitral stenosis, under vision in a surgical setting. All patients were in NYHA class III/IV. Initially single balloon was used for mitral commissurotomy followed by double balloon, before completing the mitral valvotomy with surgical instruments whenever required. The commissural split was measured by firmly stretching the two commissures using nerve hooks and measuring the distance between the two hooks with the help of a caliper. Assessment of balloon dilation was made by calculating exact percentage of residual commissural split following balloon dilation as compared with completed mitral valvotomy. The exact percentage of commissural split was thus obtained by subtracting residual commissural split following balloon dilation from commissural split obtained after surgical open mitral valvotomy. RESULTS: Complete commissurotomy using the balloon technique was possible in two (18.2%) patients. In the remaining nine (81.8%) patients, balloon expansion provided only 50% to 80% of commissural split and required instrumental completion with good results. CONCLUSIONS: Balloon mitral commissurotomy, by virtue of its circumferential force, helps to develop a good cleavage and attains good hemodynamic improvement which may be life saving in critical mitral stenosis in selected group of patients with pliable mitral leaflets and minimal subvalvular pathology.

Adolescent↗
PubMed1986

Hepatitis B infection in ophthalmologists.

A seroepidemiologic survey of ophthalmologists in Western Pennsylvania was performed to define the hepatitis B virus (HBV) exposure risk for this subspecialty population. Of 70 participating ophthalmologists, only 5 (7.1%) had serologic evidence of prior hepatitis (positive hepatitis B surface antibody and antibody to the core antigen of hepatitis B). No participants were found to be HBsAg (hepatitis B surface antigen) positive. The infection rate for ophthalmologists appears lower than that previously described for physicians involved in surgical and nonsurgical medical specialties. However, caution is still recommended since hands and surgical instruments may become contaminated with HBV from the blood and secretions of hepatitis B patients or carriers.

Adult↗
PubMed1989

Soft-tissue-anchored percutaneous device for long-term intracorporeal access.

A percutaneous device system for long-term intracorporeal access is presented. A technical description of the device is given as well as results from healing in of device dummies and everyday functioning devices both in the short- and long-term perspectives in experimental animals and in human volunteers and patients. Major complications have not been observed by clinical inspection. Histological analyses of the animal experiments indicated that the downgrowth of the epidermal cells was arrested at the most superficial borderline of a preformed cavity region. An increased subepithelial cell density was observed lateral to a moderate sinus tract, but there were no heavy inflammatory cell infiltrations. The clinical success of the implants evaluated appears to be based on the following design factors: (1) selection of titanium as the tissue interfacing surface, (2) surface geometry factors applied, (3) a system of preformed cavities promoting connective-tissue interdigitation, (4) stress relief design of the subcutaneous flange, (5) high-precision surgical instrumentation and method. It is concluded that the results obtained so far are sufficiently promising to justify further controlled clinical trials and extended observation periods.

Animals↗
PubMed1997

Image guided surgery and its potential.

The use of higher technology in medicine promises improved outcomes and enhanced productivity. That is, successful techniques will lead to lower cost, higher quality care for a larger population. In surgery, these changes range from the more efficient use of skilled medical practitioners, through improvements to conventional practice (a recent example is the shift to endoscopic surgery in the abdomen), to the creation of new procedures which capitalize on the availability of information in new forms._Image Guided Surgery may be defined as the use of advanced technology to help the surgeon see with 1) Better resolution 2) Orientation and context setting 3) Higher contrast, and 4) Vision inside "solid objects", including the elimination of occlusion by the surgeon's tools or other external items. We describe here the current imaging processes and their limitations with regard to direct guidance of therapy. The physical properties of real time image acquisition systems are described along with the mechanisms for inherent and enhanced contrast. Examples of the use with surgical instruments or other interventional devices for image-monitored and guided procedures are then discussed, and future prospects elucidated.

Humans↗
PubMed1994

A report of 131 cases of endoscopic laser lacrimal surgery.

BACKGROUND: Despite the many advantages of endoscopic laser dacryocystorhinostomy, clinical data have been sparse, and the effectiveness of this procedure has not been fully evaluated. METHODS: Among 127 patients (131 procedures) who underwent endoscopic laser lacrimal surgery, 92 procedures with longer than 3 months of follow-up were evaluated. The authors used endoscopic sinus surgery equipment, radiosurgical instruments, otodrill, microrongeur, holmium:YAG and contact neodymium:YAG lasers. RESULTS: After the primary operation, 71 (77.2%) of 92 cases were symptom-free and had positive results on primary Jones dye test. With simple revision of failed cases, 88 (95.7%) of 92 cases were treated successfully. CONCLUSION: Improvement of surgical technique and use of adequate surgical instruments were essential in increasing the rate of success. Endoscopic laser surgery is useful in treating patients with lacrimal passage obstruction, but a longer period of observation is necessary to confirm its effectiveness.

Adolescent↗
PubMedDate not supplied

The use of CO2 laser in otolaryngology: a progress report.

Since 1971 the CO2 laser has been used in otolaryngology at Boston University School of Medicine, University of Illinois, and the Eye, Ear, Nose, and Throat Hospital, New Orleans; over 560 patients have been cared for and over 1,000 operations performed. The instruments have proved to be reliable and the use of CO2 laser relatively free of complications when appropriate precautions are taken. The nature of the laser wound is such that laser surgery has facilitated the management of numerous benign and malignant lesions of the larynx as well as the oral cavity, pharynx, and tracheobronchial tree. Laser surgery is associated with a minimal morbidity, excellent healing, minimal scar formation, and excellent residual function. The instrument has been most useful in the management of lesions situated in relatively inaccessible areas such as the nasopharynx, subglottic area of the larynx, and tracheobronchial tree. The advantages of laser surgery in otolaryngology are so significant that it can be recommended for continued usage. Many applications of this unique surgical instrument have been identified but others need to be explored in the future.

Carbon Dioxide↗
PubMed1992

Blood exposure and puncture risks for OR personnel.

1. Although all health-care workers are at risk for exposure to bloodborne organisms, OR personnel are the most intensively exposed to blood. Exposures to blood were noted in up to half of the procedures observed. 2. Risk-reduction strategies include using two pairs of puncture-resistant gloves and face protection for all procedures; wearing impermeable gowns during procedures with heavy blood loss; using surgical instruments and techniques that reduce the chance of percutaneous contacts; and adopting protocols for handling sharps, counting sponges, and cleaning the operating room. 3. Better and more comfortable personal protective equipment is needed. Manufacturers should develop risk-protective and cost-effective barriers that reduce risks for patients of surgical wound infections while reducing the risks for health-care workers of exposures to blood and bloodborne pathogens.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Characterization of tissue ablation with a continuous wave holmium laser.

BACKGROUND AND OBJECTIVE: The pulsed holmium laser is a promising tool for tissue ablation but possesses some limitations. For example, it is capable of producing significant mechanical damage in certain tissues in the form of fissures and fractures. Because longer pulse durations should reduce mechanical damage, this study examined the tissue effects produced by a prototype continuous wave holmium laser. STUDY DESIGN/MATERIALS AND METHODS: A prototype liquid nitrogen cooled holmium operating at 2.12 microns was used. The heat of ablation and ablation threshold were determined using a mass loss technique. Fresh pig skin was irradiated in air or under saline, and prepared for histologic analysis. Hemostasis was qualitatively assessed in vivo during incisions made in the skin, liver, and small intestine. RESULTS: Threshold radiant exposure and heat of ablation were calculated from the mass loss measurements to be 191 J/cm2 with a 95% confidence interval of -80-440 J/cm2. Residual thermal damage in skin ranged from 390 to 690 microns in saline and from 390 to 490 microns in air. Excellent hemostasis was achieved in all incisions. CONCLUSION: Using appropriate irradiation parameters, the continuous wave holmium laser produces tissue effects suitable for a general use surgical instrument. In addition, the laser source could become compact and inexpensive when diode-pumped and direct diode devices become available.

Air↗
PubMed2006

Impact of new technologies on the clinical and functional outcome of Altemeier's procedure: a randomized, controlled trial.

PURPOSE: A randomized study was performed to assess whether new technologies offer advantages over the conventional technique on the clinical and functional outcome of patients with full-thickness rectal prolapse and fecal incontinence, submitted to Altemeier's procedure with levatorplasty. METHODS: Between January 1999 and December 2003, 58 patients (55 females; mean age, 70.9 +/- 11.3 years) with full-thickness rectal prolapse were evaluated with continence score, colonoscopy, anorectal manometry, anal electromyography, and sacral reflex latency; 40 of them were selected and randomly assigned to two groups: 20 patients (Group 1; 19 females, 73.4 +/- 10.4 years) were submitted to a conventional operation with monopolar electrocautery and handsewn anastomosis, and 20 (Group 2; 18 females, 71.5 +/- 12.2 years) using harmonic scalpel and circular stapler. Patients were followed up with clinical examination, anorectal manometry, and anal electromyography, with mean follow-up 29.3 +/- 8.5 and 27.5 +/- 9.2 months in Groups 1 and 2, respectively. RESULTS: Operative time, blood loss, and hospital stay were significantly reduced in Group 2 (P < 0.001), whereas no differences were found in pain score, time to return to normal activity, morbidity, and mortality. Complications were two (10 percent) stenosis in Group 1. Fecal continence score significantly improved in both groups (P < 0.01), whereas anorectal manometry and neurophysiologic data were not significantly modified by the operation. Recurrence rates were 15 and 10 percent in Groups 1 and 2, respectively (P= not significant). CONCLUSIONS: The clinical and functional long-term results of perineal rectosigmoidectomy with levatorplasty are not influenced by surgical instruments and type of coloanal anastomosis. The clinical relevance of the short-term results in high-risk patients should be specifically investigated.

Aged↗