Nitinol: shape-memory and super-elastic materials in surgery.
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Alloys↗
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Results for “Surgical Instruments”
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Looking forward.
With the rapid acceleration of technology, fundamental changes in the science of surgery are emerging within the lifetime of a surgeon's practice. This review includes the technologies of information systems, robotics, virtual reality, simulation and training, directed-energy surgical instruments, photonics, and brain chips, as well as their impact on the practice of surgery. Also considered are those technologies that may replace surgery, such as genetic engineering, tissue engineering, suspended animation, and nanotechnology. The evidence for each of these technologies is presented as preliminary reports of their success in research laboratories.
Diffusion of Innovation↗
Trocar site hernia after laparoscopic ventral hernia repair.
BACKGROUND: The incidence of trocar site hernia (TSH) after laparoscopic ventral hernia repair (LVHR) is reported to be low. The present study investigates the associated risk factors, with a view to preventing this complication. METHODS: A retrospective study was made of the incidence of TSH in a personal series of LVHR, recording anthropometric and clinical data on the patients. Risk factors were assessed by bivariate and multivariate analyses. The patients were subjected to clinical and telephone follow-up. RESULTS: In a series of 27 LVHR, the incidence of TSH was 22% (6 patients). The use of meshes larger than 10 x 15 cm for LVHR was the only TSH risk factor to reach statistical significance. Female gender and diabetes showed a higher incidence in the TSH group. CONCLUSIONS: The use of large meshes may be a risk factor for TSH. We believe this to be due to dilatation of the trocar orifice during introduction of the mesh, and also to postoperative retraction of the mesh.
Adult↗
Technical advances toward interactive image-guided laparoscopic surgery.
BACKGROUND: Laparoscopic surgery uses real-time video to display the operative field. Interactive image-guided surgery (IIGS) is the real-time display of surgical instrument location on corresponding computed tomography (CT) scans or magnetic resonance images (MRI). We hypothesize that laparoscopic IIGS technologies can be combined to offer guidance for general surgery and, in particular, hepatic procedures. Tumor information determined from CT imaging can be overlayed onto laparoscopic video imaging to allow more precise resection or ablation. METHODS: We mapped three-dimensional (3D) physical space to 2D laparoscopic video space using a common mathematical formula. Inherent distortions present in the video images were quantified and then corrected to determine their effect on this 3D to 2D mapping. RESULTS: Errors in mapping 3D physical space to 2D video image space ranged from 0.65 to 2.75 mm. CONCLUSIONS: Laparoscopic IIGS allows accurate (<3.0 mm) confirmation of 3D physical space points on video images. This in combination with accurately tracked instruments and an appropriate display may facilitate enhanced image guidance during laparoscopy.
Equipment Design↗
Stapled and nonstapled laparoscopic transabdominal preperitoneal inguinal hernia repair.
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Hernia, Inguinal↗
Pneumoperitoneum upregulates preproendothelin-1 messenger RNA.
BACKGROUND: Laparoscopic pneumoperitoneum has been shown to decrease glomerular filtration rate (GFR) and urine volume (UV). Endothelin-1 (ET-1), a potent renal vasoconstrictor, has been implicated. The purpose of this study was to determine renal function, ET-1 gene expression, and peptide localization in kidneys subjected to CO2 pneumoperitoneum. METHODS: Experiments were performed in three groups of anesthetized Sprague-Dawley rats in which GFR and UV were measured before, during, and after insufflation. In the first group (n = 8), pneumoperitoneum (10 mmHg) was established for 30 min. The second group (n = 4) underwent a sham operation without pneumoperitoneum. In the final group (n = 4), kidneys were obtained from normal control animals without any prior surgical instrumentation. PreproET-1 (ppET-1) mRNA levels were measured by reverse transcription-polymerase chain reaction (RT-PCR). The ET-1 peptide was localized within kidneys by immunohistochemistry (IHC). RESULTS: Pneumoperitoneum caused a significant (p < 0.05) 87% decrease in GFR and a 79% decrease in UV from baseline, with a return to baseline values after desufflation. RT-PCR showed a significant (p < 0.05) increase in expression of ppET-1 mRNA in the laparoscopic group; it was 3.52 +/- 0.33 densitometric units (DU), as compared to 0.35 +/- 0.06 DU and 0.57 +/- 0.12 DU in the control and sham groups, respectively. IHC showed enhanced expression of the ET-1 peptide in the vascular endothelium and proximal tubular cells of the laparoscopic group compared to the control and sham groups. CONCLUSION: Pneumoperitoneum induces ET-1 gene and peptide upregulation in the kidney. Expression of ET-1 is increased in the renal vasculature and proximal tubular cells. The elevation of ET-1 and its localization may account for some of the renal dysfunction observed during pneumoperitoneum. This suggests that antagonism of ET-1 may be beneficial in patients with renal impairment undergoing prolonged laparoscopic procedures or in protecting allograft function during and after living donor nephrectomy.
Animals↗
Clinical use of a front lifting hood rectoscope tube for transanal endoscopic microsurgery.
BACKGROUND: Transanal endoscopic microsurgery (TEM), a procedure developed by Buess et al. requires a specially designed surgical rectoscope system, and adequate training for its operation is mandatory. In order to simplify the performance of TEM, and to allow the use of additional surgical instruments and devices, we have developed a new rectoscope tube. METHODS: The forward half of the tube can be opened longitudinally by hand. Our working insert platform is hollowed and includes a channel for an endoscope. The resection procedure can be performed under normal atmospheric pressure. This newly developed rectoscope system has already been employed clinically. TEM was performed using our original forward lifting hood rectoscope tube in 20 patients, including 12 cases of sessile adenoma and eight cases of early carcinoma. RESULTS: The forward hood of the tube was opened to the maximum angle of 25 degrees in eight patients and 15-20 degrees in the other 12 patients. The visible field of the rectal interior was extended in direct proportion to the angle. Through our working insert platform, instruments and devices could be used for either laparoscopic or open surgery. CONCLUSIONS: These modifications have made TEM easier and will therefore make the procedure available to more surgeons.
Aged↗
Transgastrostomal endoscopic surgery for early gastric carcinoma and submucosal tumor.
BACKGROUND: Laparoscopic intraluminal surgery of the stomach is now widely used for a lesion on the posterior wall. However, this procedure has some technical limitation related to the intricate introduction of the surgical instruments into the gastric lumen. In this article, we report our newly developed technique of transgastrostomal endoscopic surgery that overcomes this limitation and is also suitable for full-thickness gastric wall resection of a lesion in the wall. METHODS: After making a 4-cm-long temporary gastrostomy, a Buess-type endoscope is inserted into the gastric lumen through the gastrostomy. The operation is performed inside the gastric lumen under video camera guidance using electrocautery, scissors, and forceps. After resection, the wound in the mucosa or the wound after full-thickness resection is endoluminally sutured. Mucosal resection was performed in six cases of early gastric carcinoma, two cases of atypical epithelium, and one case of ectopic pancreas. Full-thickness wall resection was performed in four cases of a leiomyoma. RESULTS: In all 13 cases, the lesion could be precisely located by the video camera. All lesions were then resected endoluminally. The mean duration of the operation was 148 min. The postoperative course in all cases was uneventful. CONCLUSIONS: Transgastrostomal endoscopic surgery is minimally invasive and an efficient tissue-preserving technique for the removal of early gastric carcinoma or submucosal tumor.
Adult↗
The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons.
BACKGROUND: Endoscopic surgeons rely on visual feedback to control their movements but lack stereopsis, an important depth cue. Previous three-dimensional (3D) systems alternated images on a two-dimensional (2D) screen, which was uncomfortable for surgeons. A second-generation 3D system provides continuous stereoscopic images on a monitor suspended at arm's length. We studied its effect on the laparoscopic precision of novices and experienced surgeons. METHODS: Experienced laparoscopic surgeons (n = 12) and novices (n = 16) performed a total of 672 tasks in 2D, 3D, and under direct vision. Precision was assessed using the Imperial College Surgical Assessment Device (ICSAD), which generates objective scores of performance by analyzing the movements of surgical instruments. RESULTS: We found that 2D endoscopic vision impaired performance by 35-100% when compared with direct vision, whereas 3D reduced this endoscopic handicap by 41-53% in novices and experienced surgeons (p < 0.03). No side effects were reported with the new 3D system. Even in 2D, novices performed better with an image at arm's length (p < 0. 03). CONCLUSIONS: Second-generation 3D significantly improved the laparoscopic precision of novices and experienced surgeons, without the side effects reported from previous systems. This technology is expected to improve the ease and safety of laparoscopic surgery.
Adolescent↗
Experience with three-port laparoscopic cholecystectomy.
After considerable experience with laparoscopic cholecystectomy (LC) using four ports, we began using three-port LC in October 1993 and have performed 130 LCs with this procedure up to May 1996. The procedure was successful in 119 patients. In 6 patients fourth port was used, and in another 5, the procedure was converted to open laparo-tomy. Cooperative manipulation of the surgical instruments between the operator and assistant is very important for this procedure, for exposing Calot's triangle and dissecting the gallbladder from the gallbladder bed. The use of an ultrasonic aspiration system (Sumisonic ME 2400; Sumitomo Bakelite, Tokyo, Japan) made it easier to identify the cystic duct and artery, especially in patients with chronic inflammation or dense adhesions. We encountered no problems with cannulation into the cystic duct for intraoperative cholangiography, and there were no intra- and postoperative complications in this series. We achieved good results, similar to those achieved with the four-port technique. This technique is technically feasible and safe, and it has esthetic and cost advantages compared with the four-port technique. However, the operator who performs three-port LC should not hesitate to add another port, or to convert to open laparotomy, whenever any difficulties occur during this procedure, to prevent critical complications.
Cholecystectomy, Laparoscopic↗
Left retroperitoneal approach using a retractor to repair abdominal aortic aneurysms: a comparison with the transperitoneal approach.
PURPOSE: The purpose of this study was to compare the effectiveness of the retroperitoneal approach (RP) using a Thompson retractor with the conventional transperitoneal approach (TP), to repair infrarenal abdominal aortic aneurysms (AAA). METHODS: A total of 91 consecutive patients were divided into two groups; group A ( n = 21) underwent surgery using the TP, and group B ( n = 70) underwent surgery using the RP with a Thompson retractor. RESULTS: There were no significant differences in the operation time, aortic cross-clamp time, incidence of postoperative cardiac events, or the development of wound complications; however, a significantly higher rate of postoperative respiratory complications and ileus was observed in group A. Moreover, oral feeding was commenced later and the hospital stay was prolonged in group A ( P < 0.01). CONCLUSION: These findings clearly demonstrate that our RP method, especially when using a Thompson retractor, is a preferable alternative to TP for AAA surgery.
Age Factors↗
Temporary cardiac asystolia induced by intraoperative irritation of the eighth right sided anterior cervical nerve root.
BACKGROUND: The 60 year old women with no prior history of arrhythmia or other cardiac symptoms was operated on for a cervical disc herniation at the level C7/D1. The C8 nerve root was visualized via a posterior approach. FINDINGS: Removal of the sequestrum and irritation of the anterior root with surgical instruments triggered cardiac arrest. INTERPRETATION: We offer the opinion that irritation of the anterior root led to diminished activity of the supraspinal sympathetic control system and consecutive hyper-activation of the parasympathetic system.
Cervical Vertebrae↗
Treatment of pain from osteoporotic vertebral collapse by percutaneous PMMA vertebroplasty.
BACKGROUND: Vertebral compression fractures are common complications in advanced osteoporosis. In general, this disease of the elderly patient is characterized by severe local back pain. Pathophysiologically, bony instability triggers local pain during body movement. Serious pain immobilizes the patients and forces them to bed rest. As a result, complications like thrombosis or pneumonia occur. Invasive treatment with surgical instrumentation for vertebral stabilization is not indicated in elderly patients especially with additional diseases. The purpose of this study was to test the hypothesis that percutaneous polymethylmethacrylate (PMMA) vertebroplasty significantly reduces pain due to vertebral collapse in osteoporotic patients and improves quality of life. METHODS: A total of 38 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were treated by PMMA vertebroplasty. After admission, before discharge from the hospital, six weeks, half a year and one year later patients answered the Oswestry Low Back Pain Disability (OLBPD) Questionnaire for assessment of treatment related change in disability. In all patients percutaneous vertebroplasty was performed under local anesthesia. FINDINGS: A total of 92% of patients reported a significant pain reduction immediately after treatment. Also one year after vertebroplasty pain remained significantly reduced. Vertebroplasty was highly beneficial for patients with pain related to local instability of the spine. Extravasation of PMMA beyond the vertebral margins was observed in 26% of the cases. No treatment related clinical or neurological complications were noticed. INTERPRETATION: PMMA vertebroplasty is a useful and safe method of pain relief which rapidly regains quality of life for patients with osteoporotic vertebral compression.
Administration, Cutaneous↗
Vascular closure stapler clip anastomosis decreases aortic cross-clamping time compared to interrupted nonabsorbable and running absorbable sutures in growing pigs.
The latest generation in titanium clip application systems, the vascular closure staples (VCS) system avoids intimal lesions and therefore minimizes the subsequent hyperplastic reaction, while at the same time enhancing distensibility and vascular growth. Moreover, VCS clips allow the surgeon to perform vascular anastomosis easily and faster than conventional suture. This system may become the option of choice for vascular reconstruction in pediatric surgery where, as in the case of aortic and transplant surgery, decreasing vascular occlusion times may influence the outcomes. The aim of this study was to determine whether VCS metallic clips would allow shorter anastomosis times than conventional interrupted polypropylene or running Dexon suturing in end-to-end anastomosis performed in the abdominal aorta of young pigs. Twenty-four domestic swine, 45 days old, were used for this study. All animals were subjected to an end-to-end anastomosis in the abdominal aorta using VCS clips, interrupted polypropylene, or running Dexon suture. Aortic cross-clamping time was significantly shorter in the VCS clips group (4.02 +/- 0.72 min), compared to interrupted polypropylene (21.89 +/- 1.93 min) or running Dexon (9.82 +/- 3.97 min) suture. VCS clips are easy to use, and therefore may aid surgeons to significantly decrease the time needed for performing an end-to-end anastomosis in the abdominal aorta, thus decreasing cross-clamping time when compared to interrupted polypropylene or running Dexon sutures.
Anastomosis, Surgical↗
Evaluation of pain and disability in plug repair with the aid of a personal digital assistant.
The purpose of this paper is to illustrate the method of real-time data collection using a hand-held personal digital assistant (PDA) in the operating suite, hospital, and office. The technique for the placement of a round Atrium ProLite self-forming, layered polypropylene plug in 155 hernia repairs is described. The study measured postoperative pain by the number of pills used (6.6) and categorizes patient return to work according to sedentary, manual, and standing with an average return to work time of 15.6 days for unilateral repair and 20.4 days for bilateral repair. Return to normal daily activity was within 22.3 days for unilateral- and 28.5 days for bilateral repair.
Computers, Handheld↗
Inguinal hernioplasty: the gold standard of hernia repair.
On the basis of a critical review of 936 inguinal hernioplasties performed in 8 years, the authors present their good long-term results with tension-free techniques including the original Lichtenstein technique, Lichtenstein with a sutured mesh and annulorrhaphy of the deep inguinal ring, and Lichtenstein with plug. The only two recurrences in this case series occurred with the original technique. Suturing of the mesh and deep inguinal ring annulorrhaphy proved to be reliable and inexpensive. Results were equivalent with the use of the plug, despite the presence of an additional foreign body. In conclusion, the results obtained with the three variants are practically equivalent, and the choice of technique may depend on the preference and experience of the surgeon.
Adolescent↗
Implications of prion diseases for neurosurgery.
Prion diseases comprise a group of diseases characterised by transmissibility, spongiosis, gliosis, neuronal loss, and accumulation of an abnormally folded membrane protein, PrP(Sc). Infectivity resists almost all chemical and physical processes that inactivate conventional viruses, whereas protein extraction abolishes infectivity. This fact is of great importance to surgery, especially neurosurgery, since conventional cleaning of surgical instruments does not abolish infectivity. As a matter of consequence, few cases of putative neurosurgical transmission of Creutzfeldt-Jakob disease (CJD) have been reported. Putative transmission has also been reported through the use of lyophilised dura mater, corneal transplants, and cortical EEG electrodes. Moreover, many children have been infected with CJD by intramuscular or subcutaneous injection of cadaveric pituitary-derived human growth hormone. In recent years, the occurrence of bovine spongiform encephalopathy and consequently new variant Creutzfeldt-Jakob disease has increased concerns that prions also may contaminate the blood supply. Animal models of prion disease can help the understanding of how prions spread within an infected organism and the identification of which tissues may be contagious. Taking the right precautions against iatrogenic transmission requires knowledge about the nature of prion diseases - not only for the persons working out the directives but also for health care workers potentially involved with CJD patients or contaminated specimens.
Humans↗
The level of ganglion clipping for hyperhidrosis.
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Blushing↗