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At least 1,153 records · Page 64Linked to original sources
PubMed1997

Surgical navigation using audio feedback.

Current medical visualization technology intended for positional guidance in surgical applications may only ever have limited utility in the operating room due to the preexisting visual requirements of surgical practice. Additionally, visual systems impose limits as a result of their high latency, poor image resolution, problems with stereopsis and physical strain upon the user. Audio technology is relatively unexamined in the broad range of available methodologies for medical devices. The potential to translate surgical instrument position into audio feedback presents a novel solution to the human factors and engineering problems faced by visual display technology because audio technology employs a rich and as yet unburdened sensory modality. We describe an experimental system we have developed for investigating this new interface design approach using commercially available hardware.

Auditory Perception↗
PubMed2004

Endoscopically assisted removal of tumors in the frontal region.

BACKGROUND: Advancements in endoscopic surgery, due in part to patient demands and in part to provision of superior medical care by surgeons, have significantly contributed to improvements in patients' quality of life. An endoscopic operation is minimally invasive, associated with faster recovery, and produces less postoperative morbidity. It is a well-accepted procedure in the field of plastic surgery. By applying the principle of endoscopic surgery used in facelift operations, we performed tumor excision in the forehead region. METHODS: Two 1.5-cm slit incisions were made in the anterior hairline. One incision was to allow access for the 4.0-mm, 30 degrees endoscope, and the other was for surgical instrumentation. These incisions, determined by the plane of dissection, were more superficial and below the subgaleal layer for soft tissue tumors and deeper into the subperiosteal layer for bone tumors. With good illumination and magnified monitor viewing, the tumors could clearly be visualized and were completely excised. RESULTS: Seven patients with either dermoid cysts (3), osteomas (2), or lipomas (2) underwent endoscopically assisted procedures. In all cases, tumors were successfully excised with no acute or chronic complications. The average postoperative follow-up period was 7 months. No incidence of tumor recurrence was reported. All patients were satisfied with the resultant forehead contour and surgical scars. CONCLUSIONS: The main advantage of this procedure is the fact that it is minimally invasive, thus reducing the incidence of injury to the neurovascular structures of the forehead as well as minimization of scar visibility. In conclusion, an endoscope-assisted approach is a good alternative method for managing benign soft-tissue and bone tumors in the forehead and brow region.

Adolescent↗
PubMed1996

Unresolved issues in laparoscopic splenectomy.

BACKGROUND: Laparoscopy is now expanding to surgery of intra-abdominal solid organs such as splenectomy for hematologic diseases. The purpose of this study is to further demonstrate that laparoscopic splenectomy is feasible for the surgeon, teachable for the resident, and beneficial to the patient and to revise prior contraindications to this minimally invasive approach. METHODS: Thirty-three consecutive cases of laparoscopic splenectomy were performed between May 1992 and March 1996. The series included 21 females and 12 males with a median age of 42 years (range 19-79) and a median weight of 73 kg (range 36-115). Indications included: immune thrombocytopenic purpura (20), hemolytic anemia (5), hereditary spherocytosis (4), infarction with abscess (1), Hodgkin's lymphoma (1), Gaucher's disease (1), and AIDS-related thrombocytopenia (1). Dissection was predominately performed with a new surgical instrument, the harmonic shears, and main vessels were controlled with clips. RESULTS: Thirty-two (97%) of the cases were completed laparoscopically, with 1 (3%) conversion to control hilar bleeding. Four patients underwent simultaneous cholecystectomy. The median spleen size was 13 cm (range 8-28) and median weight was 256 g (range 40-2100). Median operating time was 242 minutes (range 85-515). Morbidity occurred in 2 (6%) patients: ileus and small bowel obstruction. Median hospital stay was 4 days (range 2-14). There was no mortality in our series. Median follow-up was 20 months (range 1-46) with no evidence of late surgical complication or recurrent disease. CONCLUSION: Laparoscopic splenectomy may be successful in cases previously considered contraindicated, particularly splenomegaly and splenic infarct with abscess. It is a procedure that can be learned under appropriate guidance in academic centers.

Adult↗
PubMed1999

Modeling surgical expertise for motor skill acquisition.

BACKGROUND: This work is part of an ongoing effort to introduce an innovative medical teaching technique to assist the efficient acquisition of surgical hand skills required to perform an inguinal hernia repair with a McVay technique. The purpose was to determine the effect of expert cognitive modeling, auditory elaboration, and split-screen video analysis on the surgical hand movements required while performing inguinal hernia surgery on cadavers. PURPOSE: Six surgical residents were videotaped performing a McVay procedure inguinal hernia in a pretest-posttest control group design. The experimental group received expert cognitive modeling, auditory elaboration, and split-screen analysis after the pretest. RESULTS: A distinct advantage for surgical instrument control and manipulation was found for the experimental group on the posttest surgeries. Less time was required to perform the operation, and more purposeful movements were exhibited by the experimental group. CONCLUSION: The treatment condition favored mindfulness learning of the McVay technique for an inguinal hernia repair.

Cadaver↗
PubMed2005

[Significance and technique of autologous chondrocyte transplantation].

The bad risk for an early onset of osteoarthritis in the knee increases with the size of a cartilage defect. A collateral meniscus- or ligament-tear will enforce this hazard in addition. In order to avoid such a development, relevant full-thickness cartilage defects should be reconstructed biologically and attendant meniscus- or ligament-tears as well as varus- or valgus deformities should be treated. A number of studies, including some prospective-randomized trials, have shown that autologous chondrocyte transplantation (ACT) is the most reliable procedure for a surgical treatment of full-thickness cartilage defects larger than 4 cm (2) in adults. One disadvantage of ACT is the extensive approach to the joint and often a hypertrophy of the repair tissue. To solve these problems, some different biomaterials for a matrix-assisted ACT have been developed. The scaffold we use has a covering membrane upside and a collagen-sponge carrying the chondrocytes. By means of special surgical instruments a minimally invasive implantation is possible, reducing the side-effects of an extensive approach. Animal studies showed the regeneration of a hyaline cartilage using our described system. However, results of current clinical studies with the different scaffolds must be awaited before an universal application of matrix-assisted ACT can be recommended.

Adult↗
PubMed2005

Lumbar synovial cysts of the spine: an evaluation of surgical outcome.

OBJECTIVE: Our aim was to study the outcomes and results of surgically treated patients with synovial cysts of the lumbar spine in our institution. METHODS: Retrospective data from 39 consecutive patients, treated during the period of December 1996 to August 2004, were analyzed. Twenty-eight men (70%) and 11 women (30%) of mean age 63.3 years were studied. All pre- and postoperative signs, symptoms, extension/flexion radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) with or without myelography were reviewed. All underwent surgery for synovial cysts with excision and decompression. Additional fusion in 26 patients was performed; 22 of them had degenerative spinal spondylolisthesis. Nine (23%) patients had prior decompression procedures, with three (8%) having had prior spinal instrumentation. Surgical outcomes were evaluated according to a questionnaire scoring system (scale of 1-4; 4 = excellent, 3 = good, 2 = fair, 1 = poor). Various preoperative attributes such as gender, age, weight, and height were analyzed to see if they had any effect on the outcome of surgery. Modified musculoskeletal outcomes data evaluation and management system (MODEM), questionnaire was provided to all; 24 (62%) responded. The following categories were determined: excellent (<20), very good (21-40), good (41-60), fair (61-80), and poor (81-100). Postoperative complications were also recorded. RESULTS: All patients had pain in their lower extremities, with 62% experiencing pain bilaterally. Ninety-five percent had pain in their back and 36% in the buttocks (36%). Eighteen (46%) patients had CT myelography. A total of 42 cysts were found. Two patients had bilateral cysts at L4-L5 level. Histology revealed two hemorrhagic cysts. The average duration of surgery was 231 minutes (range 92-391 minutes), and a mean blood loss of 930 mL (range 200-2500 mL) was recorded. Two operative dural tears and one postoperative wound dehiscence were observed. One patient had a recurrent synovial cyst at the site of original surgery. Eight patients (four each in the fusion and nonfusion group) had junctional degeneration and symptoms. A regression analysis performed on age, height, weight, and gender showed that they were not determining factors of surgical outcome. Surgery of spinal cysts at L4-L5 segment produced good and those at L5-S1 and multilevel excellent results. Patients with spinal segment fusion had superior outcomes, with 80% having excellent or good outcomes versus approximately 70% without fusion. With the modified MODEM questionnaire, 22 of the 24 (92%) patients scored between excellent, very good, and good. Two patients scored in the fair range, and none of the 24 patients scored in the range of poor. CONCLUSIONS: Spinal cysts are commonly found at the L4-L5 level, the site of maximum instability. MRI is the tool of choice for diagnosis. The etiology is still unclear, but underlying spinal instability has a strong association for formation of spinal cysts and worsening symptoms. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with fusion remain an appropriate option. The optimal approach for patients with juxtafacet cysts remains unclear. The best surgical treatment approach for each particular individual appears to remain speculative.

Adult↗
PubMedDate not supplied

Historical perspectives of ankle arthroscopy.

Ankle arthroscopy is a relatively recent specialty. This is because technology lacked the expertise to develop instrumentation small enough to be used effectively within a restricted joint space. This caused primary attention to be focused upon the larger knee joint, but both the knee and ankle had their common arthroscopic origin. This includes simple specula and crude cystoscopes and endoscopes. The lighting ranged from mere reflected sunlight, to wax candles, to crude burning filaments, to simple gas and electric lamps. Early workers included prism and lens grinders, optical physicists, and a host of other scientific specialists. This presentation includes many of the important pioneers and their contributions, as well as a chronicle of arthroscopy's most primitive roots and its transcendency into an accurate surgical instrument.

Ankle Joint↗
PubMed2000

[Thoughts on the use of mechatronic implantation aids in minimal approaches in hip prostheses].

A new concept of THR surgery is presented: A combination of limited surgical approach, intraoperative digitizing, and use of a semi-active robot shows the important advantage of easy registration, reproducible positioning of surgical instruments, and less invasive surgery. Using this system originally designed for accurate socket implantation, it will be possible to perform total THR in the future. For preoperative planning, we are currently investigating the use of biplanar digital radiographics with transformation into a 3D-model in order to avoid CT scans in the pelvic area.

Arthroplasty, Replacement, Hip↗
PubMed1997

Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications.

OBJECTIVE: We describe the development and implementation of a new open configuration magnetic resonance imaging (MRI) system, with which neurosurgical procedures can be performed using image guidance. Our initial neurosurgical experience consists of 140 cases, including 63 stereotactic biopsies, 16 cyst drainages, 55 craniotomies, 3 thermal ablations, and 3 laminectomies. The surgical advantages derived from this new modality are presented. METHODS: The 0.5-T intraoperative MRI system (SIGNA SP, Boston, MA), developed by General Electric Medical Systems in collaboration with the Brigham and Women's Hospital, has a vertical gap within its magnet, providing the physical space for surgery. Images are viewed on monitors located within this gap and can also be acquired in conjunction with optical tracking of surgical instruments, establishing accurate intraoperative correlations between instrument position and anatomic structures. RESULTS: A wide range of standard neurosurgical procedures can be performed using intraoperative MRI. The images obtained are clear and provide accurate and immediate information to use in the planning and assessment of the progress of the surgery. CONCLUSION: Intraoperative MRI allows lesions to be precisely localized and targeted, and the progress of a procedure can be immediately evaluated. The constantly updated images help to eliminate errors that can arise during frame-based and frameless stereotactic surgery when anatomic structures alter their position because of shifting or displacement of brain parenchyma but are correlated with images obtained preoperatively. Intraoperative MRI is particularly helpful in determining tumor margins, optimizing surgical approaches, achieving complete resection of intracerebral lesions, and monitoring potential intraoperative complications.

Biopsy↗
PubMed1993

[Laparoscopic surgery in pediatrics: the point of view of the anesthetist].

Data were collected from a retrospective audit in anaesthetists members of the French Association of Anaesthetists in Paediatrics (ADARPEF) and from the prospective study of the author's practice of appendectomy using open or laparoscopic surgery. Retrospective data obtained in 9 of the 16 answering centres show that contraindications include respiratory disability, cardiopathy and age lower than 5 years when surgical instruments of proper size are not available. Monitoring included electrocardioscope, non invasive arterial pressure, pulse oximetry and capnography. Three centres excluded halothane due to possible cardiovascular concern. In two institutions N2O was omitted to limit the size of potential gas embolism. Intraoperative events included high PETCO2 (37%), high arterial pressure (10%), low arterial pressure (3%), bradycardia (1%), hypoxia (0.5%) and one case of pneumothorax. In the appendectomy series, laparoscopy increased the duration of the procedure, and therefore intraoperative opioids requirements. Arterial pressure was higher in this group, irrespective to intraabdominal pressure and to PETCO2. No significant improvement in postoperative analgesia was found. It is therefore recommended to pay special attention to intraoperative anaesthetic and surgical management of children undergoing laparoscopic surgery, particularly in newborns and infants. The high incidence of minor intraoperative adverse events should be balanced by increased postoperative benefit to the patient which has not yet been demonstrated in children.

Anesthesiology↗
PubMed1990

A new 'enterocompressor' to facilitate rectal anastomosis.

A newly devised enterocompressor facilitates low rectal anastomosis in children with Hirschsprung's disease. This simple surgical instrument, composed of two semicylindrical valves, a hinge, and a regulating screw, maintains intestinal anastomoses properly placed and produces spur crushing. In addition, it is inexpensive and reusable. The enterocompressor, used in 33 primary and 15 secondary Duhamel operations, and applied to normalize intestinal transit in 10 colectomies, provided adequate anastomosis and prevented leakage of intestinal contents. This enterocompressor can be used safely in children as young as six months of age.

Adolescent↗
PubMedDate not supplied

Attributable testing for abnormal prion protein, database linkage, and blood-borne vCJD risks.

CONTEXT: National prospective collection of tonsillar tissue to be tested anonymously for abnormal lymphoreticular accumulation of prion protein (PrP) was approved to begin in the UK in 2004. The UK is not, however, testing autopsy specimens attributably for abnormal PrP (PrP(SC)) so that recipients at risk after a blood transfusion from, or exposed to surgical instruments from, a deceased carrier of variant Creutzfeldt-Jakob disease (vCJD) can be followed up to quantify transmission risks. In Switzerland, surveillance for subclinical vCJD includes unconsented testing in autopsies: consented testing of tonsillar tissue is potentially attributable to interrupt human-to-human vCJD transmission or treat it. STARTING POINT: The UK announced its first case of probable blood-borne vCJD transmission in December, 2003, and first detected a case of probable blood-borne subclinical vCJD in July, 2004. To reduce the possible risk of onward transmission to other people, UK patients who had received vCJD-implicated plasma products are being contacted. They, and their general practitioner, are asked to inform anyone giving them medical, surgical, or dental treatment, and the patients must refrain from donating blood, tissues, or organs. WHERE NEXT? Prudent additional surveillance options for human PrP(SC)--particularly at autopsy or to sanction the release of quarantined operation sets pending effective decontamination--can be costed by reference to results for cattle and sheep. Some ethical or legal impediments to the UK's potentially-attributable testing for PrP(SC) may yet be rued.

Animals↗
PubMed1995

Intra-articular calcaneal fractures. Current concepts.

Intra-articular fractures of the calcaneus should be treated like any other fractures of major weight-bearing joints. Technology has advanced significantly in the evaluation of such complex pathology. Surgical instrumentation is now available to address any fracture classification. In the past, this had been a problem, as maintenance of the anatomic reduction, rigid internal/dynamic external fixation, and early mobilization may not have been attainable. The two remaining major variables are the mechanism of injury and its force that creates the fracture in combination with a very complex intra-articular anatomical structure. There will always be some morbidity in complex and serious fractures, but at least a more favorable outcome may be attainable with application of the current concepts discussed in this text. Finally, the most crucial factor when dealing with this trauma is the skill of the surgeon, which includes his or her decision-making, preoperative planning, surgical acumen, atraumatic technique, experience, and training and postoperative management of possible complications.

Calcaneus↗
PubMed1996

Dr. Norman Bethune as a surgeon.

Dr. Norman Bethune's recognition as a Canadian of renown resulted from his devoted work in China during the late 1930s. He had received a general surgical training, but his personal illness with tuberculosis led him to specialize in thoracic surgery. A surgical program at McGill University under Dr. Edward Archibald, a pioneer thoracic surgeon, was initially successful, but by the mid-1930s Bethune was rejected by McGill and Dr. Archibald. He became chief of thoracic surgery at the Hôpital du Sacré-Coeur outside Montreal. H developed thoracic surgical instruments and wrote numerous scientific papers. The outbreak of civil war in Spain in 1937 attracted Bethune to oppose what he viewed as fascist aggression. He went to Spain, where he established the value of mobile blood banking. On his return to Canada in 1937 he became aware of the escalating war between China and Japan. He joined the Chinese communist forces in northern China and spent 18 months doing Herculean mobile war surgery, while improving the state of medical services in primitive, depressing conditions. He died in 1939 at the age of 49 years of septicemia as a result of accidental laceration of his finger during surgery. The Chinese have venerated Norman Bethune and stimulated his memorialization in Canada. His surgical record can be viewed as mixed in quality, but overall his performance remains impressive for its achievement.

Canada↗
PubMed2006

Self-retaining 27-gauge transconjunctival chandelier endoillumination for panoramic viewing during vitreous surgery.

PURPOSE: To report the development of a 27-gauge self-retaining transconjunctival chandelier endoilluminator for panoramic viewing during vitrectomy. DESIGN: New surgical instrument. METHODS: The tip of the illuminating fiber is 27-gauge (0.35 mm) and shaped like a cone to provide wide-angle illumination. The tip, inserted approximately 3 mm into the vitreous cavity transconjunctivally, provides diffuse illumination. The optical fiber covered by a malleable sleeve can be retained in the eyeball without a suture. RESULTS: The slim light fiber design (0.35 mm) stabilizes the 27-gauge tip in the eye and provides up to 25 lumens of measured illumination. The adequate lighting potential and self-retaining design allow wide-angle visualization and bimanual manipulation in challenging cases. Easy insertion and removal without suture placement make it convenient to change the position of the device during surgery and efficiently shorten surgical time. CONCLUSIONS: This suture-free 27-gauge endoillumination chandelier improves the efficacy and efficiency of vitreous surgery.

Conjunctiva↗
PubMed2006

Liposuction and VASER.

VASER is a fat pretreatment device based on the emission of pulsed or continuous ultrasound energy to emulsify fat before its aspiration by means of suction-assisted lipoplasty or power-assisted lipoplasty. If compared with previous generation UAL machines, it carries important technologic advances that focus on the safety and efficiency of the process. VASER is the result of improvements in surgical instrumentation and technique, proper use of wetting solutions, and knowledge about the best use of ultrasound for fat fragmentation. With its thinner cannulas and decreased use of ultrasonic energy, it allows greater emulsification of fat, creates more tunnels, diminishes the operative time, preserves vessels and nerves, and causes less pain and hematomas.

Catheterization↗
PubMed2000

Robotics in child neurosurgery.

We felt there was a need for a new device with "minimal invasive" tracking hardware, to be used in image-guided neurosurgery, and the system we designed to fill this need is now presented. It combines precision of movement, stability and self-positioning capabilities together with optically tracked registration and procedural control within the structure of a surgical microscope. The results are reduced setup time and minimal "distraction" from the procedure itself, factors of special relevance in child neurosurgery. The system is composed of a six-axis industrial robot suitable for use in the operating room, carrying a surgical microscope. Three progressive scan-synchronized infrared cameras mounted around the lenses of the scope are used to register the patient's position and track surgical instruments with reference to the registered space. Orientation of the microscope during surgery is obtained with a six-axis joystick used as a microscope handle. The system has been clinically used in 14 cases, and it has proven itself to be reliable, providing the expected performance advantages. The implementation of a tracked ultrasound or endoscope intraoperative imaging source is also described.

Brain Diseases↗