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At least 1,063 records · Page 59Linked to original sources
PubMed2002

Totally endoscopic atrial septal defect repair with robotic assistance.

BACKGROUND: The development of minimally invasive cardiac surgery has been characterized by the performance of increasingly complex operations through progressively smaller incisions. Computer (robotic) enhancement has emerged as a potential facilitator of these procedures, initially by providing enhanced endoscopic camera control and, more recently, by allowing the manipulation of surgical instruments through limited thoracic incisions. This report describes the next step in this progression, namely the performance of an atrial septal defect (ASD) repair entirely through thoracoscopic port incisions. This represents the first U.S. application of robotic technology for totally endoscopic open-heart surgery. MATERIALS AND METHODS: A 33-year-old woman with a secundum atrial septal defect underwent totally endoscopic repair through four port incisions by means of the Da Vinci (Intuitive Surgical, Mountain View, CA) robotic surgical system. Cardiopulmonary bypass was achieved peripherally (femoral Estech endoaortic balloon cannula; femoral and right internal jugular venous Bio-medicus cannulae). The myocardium was protected with antegrade cold blood cardioplegia delivered through the distal port of the arterial cannula. After port insertion, the entire operation, including pericardiotomy, bicaval occlusion, atriotomy, atrial septopexy, and atrial closure, was performed by computer-aided control of a camera and two instrument arms manipulated by a surgeon seated 15 feet away. The fourth port was used for suction and suture passage by the patient-side assistant. The aortic cross-clamp time was 43 minutes, and the postoperative transesophageal echocardiogram demonstrated normal ventricular function and the absence of interatrial shunting. The patient was extubated on the night of surgery, was ambulatory within 15 hours, and was discharged on the morning of postoperative day 3, 63 hours after the procedure. At 30-day follow-up, the patient was well and without complaints, and transthoracic echocardiogram confirmed the continued absence of interatrial shunting. CONCLUSIONS: Computer-aided robotic surgical technology can be used to perform open-heart procedures with a totally endoscopic approach. The benefits of this approach may include decreased perioperative pain, decreased recovery times, and improved cosmesis and patient acceptance. Clinical trials currently in progress will demonstrate whether this technology will be of reproducible value in the management of patients with intracardiac disease on a larger scale.

Adult↗
PubMed1991

Effect of intravenous cocaine on uterine blood flow in the gravid baboon.

Cocaine abuse during pregnancy is associated with adverse perinatal outcome, believed to be a result of potent vasoconstrictive effects that cocaine has on the maternal cardiovascular system. The direct effect of cocaine on the pregnant, nonhuman primates' uterine vasculature in vivo has not been examined. We investigated the effects of intravenous cocaine on maternal arterial blood pressure, uterine blood flow, and uterine vascular resistance in four unanesthetized, chronically instrumented pregnant baboons. Baboons were instrumented during the latter half of pregnancy, placing an ultrasonic flow probe around one uterine artery and catheters in the maternal inferior vena cava and aorta. Bolus intravenous cocaine hydrochloride doses of 0.05 mg/kg, 0.1 mg/kg, and 0.3 mg/kg by maternal weight were infused 30 minutes apart at least 5 days after surgical instrumentation. The maternal blood pressure rose 7.3% and 12.0% after the 0.1 mg/kg and 0.3 mg/kg cocaine infusions, respectively, and the uterine blood flow fell in a dose-dependent fashion 13.1% and 22.7%. Plasma norepinephrine levels rose in response to the 0.3 mg/kg cocaine infusion. These studies show that low doses of cocaine significantly reduce uterine blood flow in the pregnant baboon in a dose-dependent manner by increasing uterine vascular resistance.

Animals↗
PubMed1996

Laparoscopic Removal of a Large Leiomyoma Using Airlift Gasless Laparoscopy

Some discrepancies still exist with regard to the efficacy of laparoscopic removal of large symptomatic leiomyomas. In our experience, when performing myomectomy, airlift gasless laparoscopy has several advantages. First, a small incision can be made, through which conventional surgical instruments (endoscopic equipment is not required) are inserted and the myomectomy is efficiently performed. Second, the large excised leiomyoma can be cut into strips easily with a conventional long knife and removed through a small abdominal incision. Third, sutures can be placed easily, and the surgeon can place fingers through a small surgical wound to palpate the organ and tie the knot directly. Fourth, high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitoneum. Finally, the potential risks of metabolic and hemodynamic instability due to carbon dioxide insufflation to establish pneumoperitoneum are avoided.

Journal Article↗
PubMed2002

Ultrasound-guided decompression of the spinal canal in traumatic stenosis.

The purpose of this study was to examine the efficacy of ultrasound (US)-guided decompression of the myelon in the surgical treatment of spinal fractures. Intraoperative ultrasonography was performed in 22 patients with traumatic stenosis of the spinal canal during spinal cord surgery with removal of retropulsed bony fragments. US imaging requires a posterior approach and an enlarged foramen interarcuale. The posterior vertebral facet and the myelon can accurately be distinguished from small bony fragments by ultrasonography. Pre- and postoperative computed tomography was compared with intraoperative US imaging. Complete decompression of the spinal canal was controlled by US imaging of the restored ventral epidural space, as seen after repositioning of displaced fragments. Thus, the required extent of the surgical procedure was determined by intraoperative ultrasonography. We conclude that intraoperative US imaging is an important tool to monitor the restoration of the spinal canal and decompression of the spinal cord in case of fracture. The repositioning of stenosing bony fragments using surgical instruments can be monitored. US imaging as a real-time method intraoperatively provides the surgeon with additional information and significantly influences treatment options.

Decompression, Surgical↗
PubMed2005

Submandibular gland endoscopic resection: a cadaveric study.

Recent advancement of head and neck surgery has been marked by the development of endoscopic and video-assisted minimally invasive surgery. This study reports the feasibility of endoscopic submandibular gland resection in human cadavers. Twelve submandibular gland resections were performed in six human cadavers. A 30 degrees angle endoscope and conventional surgical instruments were inserted through two 15 mm submandibular incisions. Dissection was carried out bluntly with scissors in an avascular plane superficial to the gland. No insufflation was needed since transcutaneous sutures lead to effective retraction. Facial vessels, the lingual nerve and Wharton's duct were identified and protected. Vascular ligatures were performed using surgical miniclips. After the procedure, an open submandibular dissection was performed to control the integrity of the anatomical structures. In all cases, the resection of the submandibular gland was successful without the need for an additional incision. Injuries of the facial artery and lingual nerve occurred when the procedure was carried out initially. The operative time decreased with training, from 120 min for the first cases to 35 min for the later ones. In conclusion, endoscopic submandibular gland resection is possible without major difficulty. Training and experience reduce the operative time and the complication rate.

Aged↗
PubMed1995

[A new surgical system for endoscopic paranasal sinus surgery].

Functional endoscopic sinus surgery (FESS) is the treatment of choice in the majority of chronic inflammatory diseases of the paranasal sinuses. Currently used surgical instruments for FESS are based on a "grab and tear"-approach, thus predisposing to increased bleeding--especially in nasal polyps--which can significantly reduce the visual field and might lead to consecutive complications, including the injury of the anterior skull base and optic nerve. In the present paper the author introduces a new surgical system, invented by Setliff and Parsons (8), which enables the rhinosurgeon to operate in a near-bloodless field, thus providing an unimpaired vision for a safer approach to the paranasal sinuses. In addition, the system ensures meticulous cutting of tissue instead of tearing, which also reduces the risk of complications. Our experiences with the "micro debrider system" have confirmed the usefulness of this instrumentarium, especially in the operative management of nasal polyps, in terms of less traumatic surgery and better visual field, thus implying fewer complications during FESS.

Debridement↗
PubMed2001

Intracranial image-guided neurosurgery: experience with a new electromagnetic navigation system.

BACKGROUND: The aim of image-guided neurosurgery is to accurately project computed tomography (CT) or magnetic resonance imaging (MRI) data into the operative field for defining anatomical landmarks, pathological structures and tumour margins. To achieve this end, different image-guided and computer-assisted, so-called "neuronavigation" systems have been developed in order to offer the neurosurgeon precise spatial information. METHOD: The present study reports on the experience gained with a prototype of the NEN-NeuroGuard neuronavigation system (Nicolet Biomedical, Madison, WI, USA). It utilises a pulsed DC electromagnetic field for determining the location in space of surgical instruments to which miniaturised sensors are attached. The system was evaluated in respect to its usefulness, ease of integration into standard neurosurgical procedures, reliability and accuracy. FINDINGS: The NEN-system was used with success in 24 intracranial procedures for lesions including both gliomas and cerebral metastases. It allowed real-time display of surgical manoeuvres on pre-operative CT or MR images without a stereotactic frame or a robotic arm. The mean registration error associated with MRI was 1.3 mm (RMS error) and 1.5 mm (RMS error) with CT-data. The average intra-operative target-localising error was 3.2 mm (+/- 1.5 mm SD). Thus, the equipment was of great help in planning and performing skin incisions and craniotomies as well as in reaching deep-seated lesions with a minimum of trauma. INTERPRETATION: The NEN-NeuroGuard system is a very user-friendly and reliable tool for image-guided neurosurgery. It does not have the limitations of a conventional stereotactic frame. Due to its electromagnetic technology it avoids the "line-of-sight" problem often met by optical navigation systems since its sensors remain active even when situated deep inside the skull or hidden, for example, by drapes or by the surgical microscope.

Adult↗
PubMed2001

Chemical anesthesia of northern sea otters (Enhydra lutris): results of past field studies.

Between 1987 and 1997, we chemically immobilized 597 wild sea otters (Enhydra lutris) in Alaska for the collection of biological samples or for surgical instrumentation. One drug-related sea otter fatality occurred during this time. Fentanyl in combination with diazepam produced consistent, smooth inductions with minimal need for supplemental anesthetics during procedures lasting 30-40 min. Antagonism with naltrexone or naloxone was rapid and complete, although we observed narcotic recycling in sea otters treated with naloxone. For surgical procedures, we recommend a fentanyl target dose of 0.33 mg/kg of body mass and diazepam at 0.11 mg/kg. For nonsurgical biological sample collection procedures, we recommend fentanyl at 0.22 mg/kg and diazepam at 0.07 mg/kg. We advise the use of the opioid antagonist naltrexone at a ratio of 2:1 to the total fentanyl administered during processing.

Anesthesia↗
PubMed1993

Laparoscopic Heller cardiomyotomy and thoracoscopic esophageal long myotomy for the treatment of primary esophageal motor disorders.

The technique of laparoscopic and thoracoscopic esophageal myotomy is described. The laparoscopic Heller procedure was performed in a patient with manometrically diagnosed achalasia and the thoracoscopic long esophageal myotomy in another with diffuse esophageal spasm. Both operations were performed in the same fashion as during open surgery, using standard laparoscopic surgical instruments. Antireflux procedures using the Dor and modified Belsey fundoplications protected patients from iatrogenic reflux. Complete relief of dysphagia in the first case and chest pain in the second has been confirmed after 2- and 4-month follow-up, respectively. Laparoscopic Heller myotomy and thoracoscopic long esophageal myotomy are technically feasible and reduce surgical trauma, hospitalization, and postoperative recovery. They offer a viable alternative for the definitive management of primary esophageal motor disorders comparable with that of open surgery.

Adult↗
PubMed2006

Transscleral intraocular lens fixation with a "homemade" needle and hook.

We describe an ab externo, transscleral, intraocular lens (IOL) fixation technique using a surgeon-fashioned 25-gauge hook, a neodymium:yttrium aluminum garnet (Nd:YAG)-modified 27-gauge needle, and 9-0 polypropylene suture. This is a simple, inexpensive technique for creating small-gauge surgical instruments to accurately and atraumatically pass 9-0 and 10-0 polypropylene sutures through sclera. Holes, through which sutures can be threaded, are "burned" near the tips of 27-gauge or 30-gauge needles with an Nd:YAG laser. Using a fine needle holder, a 25-gauge hook is fashioned from a hypodermic needle. A surgical technique incorporating 2 ab externo incisions and achieving transscleral posterior chamber IOL fixation is discussed.

Aged↗
PubMed1997

The interventional magnetic resonance unit--the minimal access operating theatre of the future?

Interventional magnetic resonance units give the surgeon the potential to use intraoperative imaging to guide the surgical procedure. The advantages of magnetic resonance (MR) over other intraoperative imaging modalities include excellent soft tissue resolution, lack of ionizing radiation and the ability to reconstruct images in any desired plane. Postulated advantages include the ability to confirm adequate tumour resection, reduction in procedure magnitude and complication rate, shortened inpatient stay and the development of novel minimally invasive techniques including the use of thermal energy to destroy lesions. Fully MR compatible anaesthetic and patient monitoring equipment is available. However, before the MR-guided minimally invasive surgery can become a reality, much work is required in the assessment and development of MR compatible surgical instrumentation and equipment. This review describes the testing and development of instruments and equipment for MR image-guided surgery that we have undertaken. We describe the techniques we employ for open and minimal access surgery within this unique environment. The difficulties of operating within such an environment and the safety issues that this engenders are discussed. The current applications of intraoperative MR in the main surgical specialities are reviewed, and possible future areas of development for MR-guided minimally invasive surgery described.

Endoscopy↗
PubMed1993

CAD-based graphical computer simulation in endoscopic surgery.

This article presents new techniques for three-dimensional, kinematic realtime simulation of dextrous endoscopic instruments. The integrated simulation package KISMET is used for engineering design verification and evaluation. Geometric and kinematic computer models of the mechanisms and the laparoscopic workspace were created. Using the advanced capabilities of high-performance graphical workstations combined with state-of-the-art simulation software, it is possible to generate displays of the surgical instruments acting realistically on the organs of the digestive system. The organ geometry is modelled in a high degree of detail. Apart from discussing the use of KISMET for the development of MFM-II (Modular Flexible MIS Instrument, Release II), the paper indicates further applications of realtime 3D graphical simulation methods in endoscopic surgery.

Computer Graphics↗
PubMed1994

[Gasless laparoscopic cholecystectomy].

The pneumoperitoneum as a precondition of laparoscopic procedures represents a restriction of the surgeons freedom of movement and causes rare but typical complications. In July 1993 we started doing laparoscopic cholecystectomy without using a pneumoperitoneum. Under direct vision and digital control the retractor blades are introduced into the abdominal cavity via minilaparotomy. The retractor is attached to an electrically powered mechanical arm and raised. The scope is introduced through the same access and the laparoscopic cholecystectomy can be performed using the established technique without instilling a pneumoperitoneum. Both conventional and laparoscopic surgical instruments were introduced through valveless trocars and unlimited suction without loss of gas and exposure is possible. Metabolic and hemodynamic alterations associated with the intraperitoneal insufflation of carbon dioxide are omitted. So far we did gasless laparoscopic cholecystectomy in 22 patients. We didn't see any related complications. Four times we had to change the surgical procedure. In comparison to the traditional laparoscopic cholecystectomy with a CO2-pneumoperitoneum the results of the first gasless procedures demonstrate possible advantages.

Adult↗
PubMed1995

Clinical applications of frameless stereotactic devices in neurotology: preliminary report.

Conventional stereotactic surgery has been utilized primarily for intracranial neuro-surgical procedures. Despite their utility, head-frame systems are restrictive and often inconvenient, thus they have not proved applicable for neurotologic surgery. Recently frameless stereotactic navigational systems have been developed that employ three-dimensional digitizers to transform the coordinates in surgical space to the corresponding image space, without the employment of head frames. This allows the determination of position of a surgical instrument in real time during surgery, and its display on video-projected computed tomography or magnetic resonance imaging scanned images. This preliminary report focuses upon an optoelectric referenced frameless stereo-tactic system, the NeuroStation, as it relates to minimally invasive neurotologic surgery. Clinical applications, limitations, and future directions are discussed, and three representative surgical cases are presented. This device has potential as an adjunctive navigational tool for certain neurotologic procedures.

Adult↗
PubMed1996

Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills.

New puncture and cut resistant hand protection systems have been developed to enhance the barrier to cuts and needle puncture injuries during surgical procedures. It is important, however, that these new hand protection systems do not reduce tactile sensitivity or dexterity during surgery. Consequently, it was the purpose of this report to compare the cutaneous sensibility and dexterity of physicians' hands covered by these new puncture and cut resistant hand protection systems to that of the standard surgical latex glove. The hide (Medak) portion of the Life Liner and the polyethylene (Spectra) portion of the FingGuard, which offered the greatest resistance to needle puncture, were associated with the greatest reduction in cutaneous sensibility, as determined by moving and static two-point discrimination, aesthesiometer pressure sensation, and discrimination of suture size and configuration. In addition, the physicians believed that the puncture and cut resistant Life Liner glove liner markedly interfered with their handling of surgical instruments. The ultimate benefit of these puncture and cut resistant hand protection systems must be determined in well-controlled clinical trials.

Discrimination, Psychological↗
PubMed2005

Historical perspective on image-guided sinus surgery.

Image-guided surgery has undergone rapid evolution, to the point where it is now a technology that is surgeon-friendly, relatively easy to set up, and reliable, making it a realistic and worthwhile option for endoscopic sinus surgery. Technologies will continue to advance as the market forces push companies to produce systems that are more accurate, faster, and more convenient. Head-tracking methodologies will likely progress away from headsets toward more reliable and safer modalities. Further integrations of surgical instrumentation, the ability to update images intraoperatively, and advancements in real-time imaging and robotics are likely to continue ata rapid rate.

History, 20th Century↗