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 1,099 records · Page 61Linked to original sources
PubMed2001

Endoscopic endonasal approaches to the cavernous sinus: surgical approaches.

OBJECTIVE: After completion of an earlier endoscopic transsphenoidal anatomic study, we studied various endoscopic transsphenoidal approaches using cadaveric specimens to develop endoscopic endonasal surgical approaches to the cavernous sinus. METHODS: Ten cavernous sinuses in five artery-injected adult cadaveric heads were studied with 0-, 30-, and 70-degree angled 4-mm rod-lens endoscopes. The extent of the surgical exposure, the skewed endoscopic anatomic view, and the maneuverability of surgical instruments through their relative operating spaces were studied after various endoscopic endonasal approaches via one nostril. RESULTS: The paraseptal approach was used between the nasal septum and the middle turbinate and provided exposure at the anteromedial portion of the cavernous sinus. The contralateral paraseptal approach rendered a slightly more medial view at the cavernous sinus than did the ipsilateral approach. This approach offered limited surgical access to the lateral vertical compartment. The middle turbinectomy approach allowed surgical access to the lateral wall of the cavernous sinus, except for the superior orbital fissure and the orbital apex. The middle meatal approach, which was made between the middle turbinate and the lateral nasal wall, revealed the entire lateral vertical compartment of the cavernous sinus, including the orbital apex and the superior orbital fissure. However, its lateral tangential surgical trajectory and the absence of dedicated surgical tools limited the surgeon's surgical maneuverability. A combination of the middle turbinectomy and middle meatal approaches increased the operating space. CONCLUSION: Various endoscopic endonasal surgical approaches to the cavernous sinus were studied using adult cadaveric head specimens.

Adult↗
PubMed2005

Development and validation of an objective instrument to measure surgical performance at tonsillectomy.

OBJECTIVES: The goals of this project were 1) to develop and validate an objective instrument to measure surgical performance at tonsillectomy, 2) to assess its interobserver and interobservation reliability and construct validity, and 3) to select those items with best reliability and most independent information to design a simplified form suitable for routine use in otolaryngology surgical evaluation. DESIGN: Prospective, observational data collection for an educational quality improvement project. METHODS: The evaluation instrument was based on previous instruments developed in general surgery with input from attending otolaryngologic surgeons and experts in medical education. It was pilot tested and subjected to iterative improvements. After the instrument was finalized, a total of 55 tonsillectomies were observed and scored during academic year 2002 to 2003: 45 cases by residents at different points during their rotation, 5 by fellows, and 5 by faculty. Results were assessed for interobserver reliability, interobservation reliability, and construct validity. Factor analysis was used to identify items with independent information. RESULTS: Interobserver and interobservation reliability was high. On technical items, faculty substantially outperformed fellows, who in turn outperformed residents (P < .0001 for both comparisons). On the "global" scale (overall assessment), residents improved an average of 1 full point (on a 5 point scale) during a 3 month rotation (P = .01). In the subscale of "patient care," results were less clear cut: fellows outperformed residents, who in turn outperformed faculty, but only the fellows to faculty comparison was statistically significant (P = .04), and residents did not clearly improve over time (P = .36). Factor analysis demonstrated that technical items and patient care items factor separately and thus represent separate skill domains in surgery. CONCLUSIONS: It is possible to objectively measure surgical skill at tonsillectomy with high reliability and good construct validity. Factor analysis demonstrated that patient care is a distinct domain in surgical skill. Although the interobserver reliability for some patient care items reached statistical significance, it was not high enough for "high stakes testing" purposes. Using reliability and factor analysis results, we propose a simplified instrument for use in evaluating trainees in otolaryngologic surgery.

Clinical Competence↗
PubMed2002

Optimizing epilepsy surgery with intraoperative MR imaging.

PURPOSE: The surgical treatment of medically intractable temporal lobe epilepsy includes the resection of temporal lobe structures. Although the reported seizure-free outcomes are highly variable, there is growing evidence that the extent of resection of the mesiotemporal lobe directly correlates with seizure control. METHODS: A moveable, high-field intraoperative magnetic resonance (MR) system was used to monitor and optimize the resection of the amygdala and hippocampus in 14 epilepsy patients. Fourteen patients with intractable seizures of temporal lobe origin underwent standard preoperative investigations including MR imaging, EEG telemetry, single-photon emission computed tomography, and neuropsychologic and sodium amytal testing. Anterior temporal lobectomy was performed on 10 patients, whereas four were treated with selective amygdalohippocampectomy. Intraoperative electrocorticography was applied as required. For all procedures, the objective was to resect the amygdala completely, and hippocampus to the posterior margin of the brainstem. RESULTS: Interdissection intraoperative MR imaging taken when optimal resection was thought to have been achieved revealed residual unresected amygdala or hippocampus in seven of 14 patients. An unexpected acute hematoma was found in one patient. At 17 months' follow-up, 13 (93%) of 14 patients are seizure free or have significantly improved seizure control. CONCLUSIONS: The mobile high-field intraoperative MR system provides high-resolution images without restriction on surgical instruments or techniques. The ability to identify and resect residual mesial temporal lobe targets before craniotomy closure is of potentially tremendous value in optimizing seizure control.

Adult↗
PubMed1991

[Use of YAG-neodymium and CO2 lasers for creating small-intestinal anastomoses].

A method for creating laser enteric anastomoses was developed in experiments with YAG-neodymium and CO2 lasers. The properties of such anastomoses were studied in detail in the early stages after the operation. The use of serial Soviet-produced laser devices and standard surgical instruments in the experiments makes it possible to introduce the results of the work into clinical practice in the near future.

Aluminum↗
PubMed1988

Survey of sterile technique used by dermatologic surgeons.

A survey was made of the sterile technique practices of dermatologists interested in dermatologic surgery. The steam autoclave is the most popular method for sterilizing surgical instruments. Dry heat sterilization is often used, as is cold, chemical sterilization. The most popular agent for chemical sterilization continues to be quaternary ammonium compounds despite warnings to the contrary. Gas sterilization is rarely used. Alcohol is the most popular agent for prepping the skin and iodophors are also quite popular. Dermatologists are now wearing gloves for most procedures. Prophylactic antibiotics are used minimally in surgical cases, as is recommended by established standards.

Dermatology↗
PubMed2006

Endoscopic third ventriculostomy in the treatment of hydrocephalus in pediatric patients.

Advances in surgical instrumentation and technique have lead to an extensive use of endoscopic third ventriculostomy in the management of pediatric hydrocephalus. The aim of this work was to point out the leading aspects related to this technique. After a review of the history, which is now almost one century last, the analysis of the endoscopic ventricular anatomy is aimed to detail normal findings and possible anatomic variations which might influence the correct conclusion of the procedure. The overview of modern endoscopic instrumentation helps to understand the technical improvements that have contributed to significantly reduce the operative invasiveness. Indications are analysed from a pathogenetic standpoint with the intent to better understand the results reported in the literature. A further part of the paper is dedicated to the neuroradiological and clinical means of outcome evaluation, which are still a matter of debate. Finally a review of transient and permanent surgical complications is performed looking at their occurrence in different hydrocephalus etiologies.

Child↗
PubMed1988

Sterilization techniques in underground surgical units in Afghanistan.

Sterilization equipment and techniques available to forward surgical units in modern conflicts past and present are sophisticated and generally taken for granted. Underground surgical units operating in rural Afghanistan must function without electricity or petroleum-powered generators and, with few exceptions, are unable to use sterilization equipment that produces intense heat for prolonged periods. We discuss the equipment and techniques developed for use by the IMC to sterilize surgical instruments, gowns, gloves, rubber goods, and sutures in the 42 clinics operating in resistance-held Afghanistan. These techniques may have application to other similar primitive conditions.

Afghanistan↗
PubMed1986

Variations in intraocular pressure during closed-system surgical procedures.

True intraocular pressure (IOP) during closed-chamber anterior segment surgery and vitrectomy was measured in rabbits by inserting a miniature pressure sensor directly into the anterior chamber or into the vitreous. Infusion fluid pressure was also measured simultaneously with a sensor in the infusion line. Significant and rapid changes in IOP up to 110 mm Hg were observed during routine anterior segment and vitreous procedures. None of these IOP changes affected infusion line pressure, which was governed solely by the infusion bottle height. Furthermore, raising the infusion bottle produced minimal IOP elevation whenever fluid was flowing into and out of the eye via a surgical instrument or a wound. These results show the limitations of monitoring of infusion line pressure as a means for assessing IOP and stress the need for IOP control during surgery.

Animals↗
PubMedDate not supplied

[Myomectomy via the vagina].

In recent years, the development of new surgical techniques in uterus myoma treatment have reduced operative trauma significantly. Our objective was to present operative technique--vaginal myomectomy, making a prospective clinical study where we have evaluated the operative and postoperative period after intentive diagnosis. The result of our study shows the feasibility of myomectomy by entering the peritoneum through the posterior vaginal fornix, using traditional and cheap surgical instruments and thus avoiding the trauma of laparatomy, minimal operative blood loss, reduced operating time and postoperative recovery. In our opinion, vaginal myomectomy could be useful for the treatment of selected cases with fundal or posterior wall uterine myomas.

Adult↗
PubMed2001

Management of complex pediatric and adolescent spinal deformity.

OBJECT: The authors sought to analyze prospectively the outcome of surgery for complex spinal deformity in the pediatric and young adult populations. METHODS: The authors evaluate all pediatric and adolescent patients undergoing operative correction of complex spinal deformity from December 1997 through July 1999. No patient was lost to follow-up review (average 21.1 months). There were 27 consecutive pediatric and adolescent patients (3-20 years of age) who underwent 32 operations. Diagnoses included scoliosis (18 idiopathic, five nonidiopathic) and four severe kyphoscoliosis. Operative correction and arthrodesis were achieved via 21 posterior approaches (Cotrel-Dubousset-Horizon), seven anterior approaches (Isola or Kaneda Scoliosis System), and two combined approaches. Operative time averaged 358 minutes (range 115-620 minutes). Blood loss averaged 807 ml (range 100-2,000 ml). Levels treated averaged 9.1 (range three-16 levels). There was a 54% average Cobb angle correction (range 6-82%). No case was complicated by the patient's neurological deterioration, loss of somatosensory evoked potential monitoring, cardiopulmonary disease, donor-site complication, or wound breakdown. There was one case of hook failure and one progression of deformity beyond the site of surgical instrumentation that required reoperation. There were 10 minor complications that did not significantly affect patient outcome. No patient received undirected banked blood products. There was a significant improvement in cosmesis, and no patient experienced continued pain postoperatively. All patients have been able to return to their preoperative activities. CONCLUSIONS: Compared with other major neurosurgical operations, segmental instrumentation for pediatric and adolescent spinal deformity is a safe procedure with minimal morbidity and there is a low risk of needing to use allogeneic blood products.

Adolescent↗
PubMed1983

Motorized teleguided stereotactic micromanipulator for vitreous microsurgery.

A recently developed motorized stereotactic micromanipulator enhances the precision of the procedure, the comfort of the surgeon, and the safety of the patient during vitreous surgery. It can accommodate almost any type of vitreous surgical instrument by means of special adapters. The system is moved by the action of electrical motors remotely controlled by the surgeon operating a joystick on a separate control unit. Electrical reversal of motion, obtained by flipping a switch, allows observation through an altered version of the Panfundoscope that provides a 160 degrees inverted fundus view during all phases of the operation. In addition to improving many aspects of present vitreous surgical procedures, this stereotactic system may initiate the development of still finer surgical methods that cannot be performed with the free hand.

Fluorescein Angiography↗
PubMed1992

Effect of artificial ventilation and anaesthesia on surfactant turnover in rats.

We have tested the hypothesis that breathing releases pulmonary surfactant via distortion of the alveolar type II cell. Gas exchange was maintained in the anaesthetized rat by applying high frequency (10 Hz) oscillations (HFO) to the chest wall; this resulted in apnoea within two to three breaths. After instrumentation under anaesthesia for 30 min, rats were infused with [3H]choline and [14C]choline, and we compared the tubular myelin-rich (PLalv-1) and -poor (PLalv-2) alveolar phospholipids and the microsomal and lamellar body phospholipids (PLlb) together with their specific activities after three forms of ventilation for 90 min: HFO (group 1), conventional mechanical ventilation (group 2) and spontaneous breathing (group 3). Group 4 was killed after surgical instrumentation and in group 5 the lungs were removed immediately after induction of anaesthesia. Groups 1-3 did not differ in any measured variable. Groups 1-4, which were anaesthetized for 30-120 min, had a lower PLalv-2 than did group 5. In contrast, PLlb was greater in groups 1-3, which were anaesthetized for 120 min, than in groups 4 and 5. In conclusion, we have successfully maintained normal gas exchange during complete apnoea by applying external HFO in rats for periods up to 90 min. Compared to mechanically ventilated or spontaneously breathing anaesthetized rats, surfactant turnover was unaltered by HFO, despite a markedly reduced tidal volume. However, the barbiturate anaesthetic itself appeared to inhibit surfactant turnover. We suggest that distortion of the type II cell may be the stimulus for surfactant release at tidal volumes above resting values.

Anesthesia↗
PubMed2000

Denis Browne: maverick or master surgeon?

The current generation of surgeons may remember Denis Browne only as an inventor of surgical instruments which few people use, an innovator of procedures condemned as inadequate, and a personality bristling with controversy: a maverick indeed. And yet this assessment belies his influence as the founder of modern paediatric surgery in the development of British surgery. Further, his innovative operations in a range of paediatric lesions were revolutionary in the context of the time. Browne was born in 1892 and educated in Australia, although his whole surgical career was in England. He had a remarkable family background; unique Australian experiences in childhood, when he commenced to display independence and individuality of spirit, through University, where he gained 'Blues' in tennis and shooting, to war, where he served in Gallipoli and France; and to controversies that surrounded him in his battle to establish paediatric surgery as a legitimate surgical discipline. He certainly had a prickly personality and a particular venom reserved for orthopaedic surgeons and anatomists, but his achievements may have been possible only by one possessed of such a strong and towering character.

Australia↗
PubMed1998

The supraorbital keyhole approach to supratentorial aneurysms: concept and technique.

BACKGROUND: Anterior surgical approaches to the base of the brain have always required relatively large craniotomies, most larger than the lesion itself. Especially in aneurysm surgery, the size of the lesion is not always proportionate to the extent of brain exposure. The improvement of surgical techniques and diagnostic imaging, as well as the introduction of neuroendoscopy and new surgical instruments, enable us now to treat various intracranial lesions through small keyholes. In particular, cerebral aneurysms, because of their anatomic characteristics, are apt to be treated by the keyhole approach. The supraorbital keyhole approach has the broadest field of indications, although its technical aspects have not yet been evaluated. METHODS: The concept and technique of the supraorbital keyhole approach are presented in detail. We conducted a retrospective study in which we evaluated the technical aspects of the supraorbital keyhole approach considering the indications, limitations, and complications of this approach as well as new instrumentation in surgery of supratentorial aneurysms. RESULTS: The use of 139 supraorbital keyhole approaches for 197 aneurysms is described. Multiple aneurysms have been treated by one approach in 38 patients. Clipping of the aneurysm was performed in 94% and wrapping in 6% of patients. Eighteen aneurysms were contralateral to the approach. In four patients, intraoperative accidental aneurysm rupture occurred. There were no approach-related complications. CONCLUSIONS: The supraorbital keyhole approach offers equal surgical possibilities with less intraoperative accidental rupture and less approach-related morbidity as conventional approaches in the treatment of supratentorial aneurysms.

Adolescent↗
PubMed1992

Corneal surface after deepithelialization using a sharp and a dull instrument.

Manual removal of the corneal epithelium currently precedes excimer laser photorefractive keratectomy. To assess the smoothness of the corneal surface following this procedure, six paired human eye-bank eyes (12 eyes) were manually deepithelialized using a blunt instrument (Paton spatula) on one eye and a sharp instrument (surgical blade) on the contralateral eye; all deepithelializations were done by the same surgeon. The 12 corneas were then resected and processed in an identical fashion for scanning electron microscopy. The microphotographs obtained showed that among the corneas deepithelialized with the blunt spatula, two had a smooth surface, and four had variable amounts of residual epithelial cells and basement membrane, confirmed by light microscopy. The surface of five corneas deepithelialized with the sharp instrument were slightly rougher than the former, with occasional linear scratches; one cornea retained a small amount of basement membrane. Removal of epithelium appears to be more complete when a sharp instrument is used. These findings may have clinical relevance, since residual epithelium and basement membrane after deepithelialization may influence the depth of ablation subsequently achieved with the excimer laser.

Basement Membrane↗
PubMed1998

Virtual reality: preparation and execution of sinus surgery.

Endonasal sinus surgery requires a great deal of training before it can be performed adequately. Due to the complex and variable anatomy and the proximity of important structures, severe complications are possible, even for experienced surgeons. The nasal endoscopy simulator (NES) is an interactive training system for nasal endoscopy and endonasal sinus surgery that combines computer graphics and virtual reality (VR) techniques. This system consists of a graphics workstation, a tracking system for measuring the position of the endoscope and surgical instruments in space, a head model, image data sets of the nasal cavity and paranasal sinus area, and complementary software. The current NES is a visual and auditory VR system that provides both educational and planning options for sinus surgery. The usual resistance when touching relevant anatomical structures is not provided by this release. Therefore, a "force feedback system" is implemented that allows for such a response. VR simulation will become an important part of surgical education and planning for individual sinus surgery procedures. The ongoing development of the NES will lead to an improved educational environment for residents in training and practitioners.

Computer Graphics↗