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Wang JJ, Huang TY, Wu CW, Lin YC, Tseng HY, Liu CH, Lu IC, Chang PY, Chen HC, Chen HY, Dionigi G, Chiang FY, Wang LF. Improving Voice Outcomes After Thyroid Surgery - Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve. Front Endocrinol (Lausanne) 2021; 12:793431. [PMID: 34899616 PMCID: PMC8662988 DOI: 10.3389/fendo.2021.793431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery.
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Affiliation(s)
- Jia Joanna Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chu Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yi Tseng
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Hsin Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Chun Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Ya Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division of General Surgery, Endocrine Surgery Section, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ling-Feng Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Bini T, Agostini C, Stolcova M, Meucci F, Di Mario C. One more option in heart failure: correction of mitral regurgitation with MitraClip ®. Intern Emerg Med 2019; 14:1033-1040. [PMID: 31297739 DOI: 10.1007/s11739-019-02140-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/26/2019] [Indexed: 01/19/2023]
Abstract
Degenerative mitral regurgitation in elderly patients and functional mitral regurgitation secondary to severe left ventricular dysfunction are not easy options for conventional surgery. Recently, a new percutaneous approach has been proposed with the MitraClip®, based on the Alfieri edge-to-edge repair technique. The aim of the study is to report, compare and discuss the results of two multicenter randomized trials: MITRA.FR and COAPT in light of the current practice. In both trials patients with functional mitral regurgitation grade 3/4+ or 4/4+ were randomly assigned, in 1:1 ratio, to undergo percutaneous repair and optimal medical therapy or optimal medical therapy alone. Other baseline characteristics reflecting severity of mitral regurgitation and of left ventricular impairment were statistically different, such as the effective regurgitant orifice area (0.31 cm2 in MITRA.FR vs 0.41 cm2 in COAPT) and the indexed LVEDV (135 ± 37 ml/m2 in MITRA.FR vs 101 ± 34 ml/m2 in COAPT). A 24 months follow-up and a 12 months follow-up have been completed, respectively, in COAPT and MITRA.FR. Out of the 307 patients enrolled in the MITRA.FR, 152 were randomized to percutaneous treatment but only in 138 (95.8%) the MitraClip® was actually implanted. At the end of the follow-up a residual mitral regurgitation of at least grade 3+ has been observed in 17% of the patients. A composite of death from any cause or unplanned hospitalizations for heart failure at 12 months respectively occurred in 83 patients (54.6%) treated percutaneously and 78 patients (51.3%) treated with medical therapy only. A total of 614 patients have been enrolled in the COAPT and 293 underwent transcatheter treatment. A successful implantation of the MitraClip® was achieved in 287 patients (98.0%). Hospitalization for heart failure at 24 months occurred in 160 patients in the device group and in 283 in the control group, with an annualized ratio of 35.8% and 67.9%, respectively (p > 0.001). The conflicting results of the two trials may have many explanations, but probably the main cause is the most stringent inclusion criteria in COAPT. The effective reduction of mitral regurgitation and improvement in exercise capacity already observed in registries including more than 70,000 patients was confirmed in a randomized trial with improvement observed in hard end-points. This has already led to an extension of FDA approval to functional regurgitation and a more liberal use across the world.
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Affiliation(s)
- Tommaso Bini
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy.
| | - Cecilia Agostini
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
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Paraskevopoulos D, Constantini S, Bal J, Roth J. Endoscope Holders in Cranial Neurosurgery: Part 2-An International Survey. World Neurosurg 2018; 111:e632-e643. [PMID: 29305118 DOI: 10.1016/j.wneu.2017.12.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/21/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Following a previous systematic review of currently available endoscope holders (EHs), we aspired to detect trends, task-specific preferences, and pitfalls of EH in various cranial neuroendoscopic procedures. METHODS A questionnaire was disseminated to members of the International Federation of Neuroendoscopy. The questionnaire evaluated indications and pitfalls of EH in different applications, in particular, differentiating between intraventricular and skull base endoscopy, as well as subcategories of these 2 main fields. Furthermore, interest or involvement in research projects on EH was investigated. RESULTS Fifty-two surgeons responded, with a broad geographic distribution represented. Most (54%) do not routinely use EH. Others use holders mainly for intraventricular rather than skull base procedures. Most surgeons (96%) regularly work with a co-surgeon. Reported weaknesses of EH included crude movements, downward drift, loss of depth perception, lack of flexibility, iatrogenic injury, cost, and bulky construct. There is still a lack of consensus on surgical indications. Tumor resections in intraventricular and skull base regions (not small sellar tumors) seem to stand out as good, widely accepted indications. CONCLUSIONS Although EH have a role in cranial neuroendoscopy, their use seems limited and their technical features are regarded as suboptimal by most neuroendoscopists. Weaknesses and implications were detected in all application categories (skull base and intraventricular) but may vary slightly. Potentially, separate systems with distinct features may be required for skull base versus intraventricular surgery. There is a need for further evolution of EH, which could lead to a future paradigm shift in their use.
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Affiliation(s)
- Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine, Queen Mary University London, London, United Kingdom.
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, United Kingdom
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Wang J, Cui Y, Wang J, Chen B, He Y, Chen M. [Clinical epidemiological characteristics and change trend of upper gastrointestinal bleeding over the past 15 years]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:425-431. [PMID: 28440524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the clinical epidemiology change trend of upper gastrointestinal bleeding (UGIB) over the past 15 years. METHODS Consecutive patients who was diagnosed as continuous UGIB in the endoscopy center of The First Affiliated Hospital of Sun-Yat University during the period from 1 January 1997 to 31 December 1998 and the period from 1 January 2012 to 31 December 2013 were enrolled in this study. Their gender, age, etiology, ulcer classification, endoscopic treatment and hospitalization mortality were compared between two periods. RESULTS In periods from 1997 to 1998 and 2012 to 2013, the detection rate of UGIB was 9.99%(928/9 287) and 4.49%(1 092/24 318)(χ2=360.089, P=0.000); the percentage of male patients was 73.28%(680/928) and 72.44% (791/1 092) (χ2=0.179, P=0.672), and the onset age was (47.3±16.4) years and (51.4±18.2) years (t=9.214, P=0.002) respectively. From 1997 to 1998, the first etiology of UGIB was peptic ulcer bleeding, accounting for 65.2%(605/928)[duodenal ulcer 47.8%(444/928), gastric ulcer 8.3%(77/928), stomal ulcer 2.3%(21/928), compound ulcer 6.8%(63/928)],the second was cancer bleeding(7.0%,65/928), and the third was esophageal and gastric varices bleeding (6.4%,59/928). From 2012 to 2013, peptic ulcer still was the first cause of UGIB, but the ratio obviously decreased to 52.7%(575/1092)(χ2=32.467, P=0.000)[duodenal ulcer 31.9%(348/1092), gastric ulcer 9.4%(103/1092), stomal ulcer 2.8%(30/1092), compound ulcer 8.6%(94/1092)]. The decreased ratio of duodenal ulcer bleeding was the main reason (χ2=53.724, P=0.000). Esophageal and gastric varices bleeding became the second cause (15.1%,165/1 092, χ2=38.976, P=0.000), and cancer was the third cause (9.2%,101/1 092, χ2=3.352, P=0.067). The largest increasing amplitude of the onset age was peptic ulcer bleeding [(46.2±16.7) years vs. (51.9±18.9) years, t=-5.548, P=0.000), and the greatest contribution to the amplitude was duodenal ulcer bleeding [(43.4±15.9) years vs. (48.4±19.4) years, t=-3.935, P=0.000], while the onset age of esophageal and gastric varices bleeding [(49.8±14.1) years vs. (48.8±13.9) years, t=0.458, P=0.648] and cancer [(58.4±13.4) years vs. (58.9±16.7) years, t=-0.196, P=0.845] did not change significantly. Compared with the period from 1997 to 1998, the detection rate of high risk peptic ulcer rebleeding (Forrest stage I(a, I(b, II(a and II(b) increased (χ2=39.958, P=0.000) in the period from 2012 to 2013. From 1997 to 1998, 54 patients underwent endoscopic treatment, and the achievement ratio of hemostasis was 79.6% (43/54). From 2012 to 2013, 261 patients underwent endoscopic treatment and the achievement ratio of hemostasis was 96.9%(253/261), which was significantly higher (χ2=23.287, P=0.000). Compared to the period from 1997 to 1998, more patients with variceal bleeding or non-variceal bleeding received endoscopic treatment in time (39.0% vs. 70.3%, χ2=51.930, P=0.000; 3.6% vs. 15.6%, χ2=62.292, P=0.000, respectively), and higher ratio of patients staging Forrest stage I(a to II(b also received endoscopic treatment in the period from 2012 to 2013 [27.4%(26/95) vs. 68.5%(111/162), χ2=40.739, P=0.000]. More qualified endoscopic hemostatic techniques were used, containing thermocoagulation (0 vs. 15.2%, χ2=79.518, P=0.000), hemostatic clip (0 vs. 55.9%, χ2=20.879, P=0.000), hemostatic clip combined with thermocoagulation (4.3% vs. 16.4%, χ2=5.154, P=0.023), while less single injection was used (87.1% vs. 6.2%, χ2=10.420, P=0.001), and single spraying for hemostasis was completely abandoned in the period from 2012 to 2013. The ratio of inpatients undergoing reoperation decreased obviously in the period from 2012 to 2013 [9.3%(86/928) vs. 6.0%(65/1092), χ2=7.970, P=0.005], while no significant difference was found in mortality during hospitalization between two periods. CONCLUSION Compared with the period from 1997 to1998, the mean onset age of UGIB increased, and the ratio of peptic ulcer bleeding decreased due to the reduction of duodenal ulcer bleeding, the detection rate of high risk peptic ulcer rebleeding increased, the cure rate of endoscopic treatment for UGIB increased, more reasonable and immediate hemostatic methods were used, but overall mortality did not change obviously in the period from 2012 to 2013.
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Affiliation(s)
| | | | | | | | | | - Minhu Chen
- Department of Endoscopy Center, Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
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Eskander MF, Neuwirth MG, Kuy S, Keshava HB, Meizoso JP. Technology for teaching: New tools for 21st century surgeons. Bull Am Coll Surg 2016; 101:36-42. [PMID: 28941430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Nakano T, Endo S. [Characteristics of customized device for video-assisted thoracoscopic surgery]. Kyobu Geka 2014; 67:721-726. [PMID: 25138945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Video-assisted thoracoscopic surgery (VATS) has been a mainstay in surgical interventions for an early staged lung cancer over a decade. VATS procedures are nowadays categorized into 2 groups. One is a modified open procedures through a mini-thoracotomy with customization of conventional instruments. The other is a port-access procedure with use of newly developed instruments for endoscopic surgery. The optimal device adapting for individual surgical manipulations should be selected to make a VATS procedure safer and more feasible. The sample extraction using a bag is a most important step when VATS is completed, because the rupture of bag can result in cancer cell contamination. More useful devices adapting either for mini-thoracotomy VATS or for port-access VATS, will be developed with advancement of medical technology.
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Affiliation(s)
- Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Japan
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Rankin TM, Giovinco NA, Cucher DJ, Watts G, Hurwitz B, Armstrong DG. Three-dimensional printing surgical instruments: are we there yet? J Surg Res 2014; 189:193-7. [PMID: 24721602 PMCID: PMC4460996 DOI: 10.1016/j.jss.2014.02.020] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/28/2014] [Accepted: 02/14/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The applications for rapid prototyping have expanded dramatically over the last 20 y. In recent years, additive manufacturing has been intensely investigated for surgical implants, tissue scaffolds, and organs. There is, however, scant literature to date that has investigated the viability of three-dimensional (3D) printing of surgical instruments. MATERIALS AND METHODS Using a fused deposition modeling printer, an Army/Navy surgical retractor was replicated from polylactic acid (PLA) filament. The retractor was sterilized using standard Food and Drug Administration approved glutaraldehyde protocols, tested for bacteria by polymerase chain reaction, and stressed until fracture to determine if the printed instrument could tolerate force beyond the demands of an operating room (OR). RESULTS Printing required roughly 90 min. The instrument tolerated 13.6 kg of tangential force before failure, both before and after exposure to the sterilant. Freshly extruded PLA from the printer was sterile and produced no polymerase chain reaction product. Each instrument weighed 16 g and required only $0.46 of PLA. CONCLUSIONS Our estimates place the cost per unit of a 3D-printed retractor to be roughly 1/10th the cost of a stainless steel instrument. The PLA Army/Navy retractor is strong enough for the demands of the OR. Freshly extruded PLA in a clean environment, such as an OR, would produce a sterile ready-to-use instrument. Because of the unprecedented accessibility of 3D printing technology world wide and the cost efficiency of these instruments, there are far reaching implications for surgery in some underserved and less developed parts of the world.
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Affiliation(s)
| | - Nicholas A Giovinco
- Department of Surgery, Southern Arizona Limb Salvage Alliance, Tucson, Arizona.
| | - Daniel J Cucher
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - George Watts
- Department of Surgery, University of Arizona Cancer Center, Tucson, Arizona
| | - Bonnie Hurwitz
- Department of Surgery, University of Arizona, Tucson, Arizona; Office of the Senior Vice President of Health Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona
| | - David G Armstrong
- Department of Surgery, Southern Arizona Limb Salvage Alliance, Tucson, Arizona
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Pearce EC, Hall JE, Boyd KL, Rousseau B, Ries WR. The ophthalmology microscalpel versus standard scalpels and wound healing in a rat model. Otolaryngol Head Neck Surg 2014; 151:424-30. [PMID: 24866476 DOI: 10.1177/0194599814536699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We tested the hypothesis that the ophthalmology microscalpel, compared to standard incisional instruments, causes less trauma during incisions resulting in decreased inflammation and greater tensile strength of wounds. STUDY DESIGN Prospective animal study. SETTING Animal laboratory. SUBJECTS AND METHODS Thirty-four Sprague-Dawley rats received dorsum skin incisions with the microscalpel, electrosurgical device, 11 blade scalpel, and 15 blade scalpel. Wounds were harvested at 1 week, 2 weeks, 3 weeks, and 6 weeks, then analyzed histologically in a blinded manner for inflammation markers and tested for tensile strength. RESULTS The microscalpel wounds had significantly higher tensile strength compared to the 15 blade (P = .045) and electrocautery device (P = .000) but equivocal strength to the 11 blade (P = .457). The electrocautery wounds were weaker than all 3 steel blades. No significant difference was found between the microscalpel, 11 blade, and 15 blade incisions for the 5 markers of inflammation. Electrocautery wounds had significantly worse inflammatory scores, specifically, higher angiogenesis and larger wound gap compared to the microscalpel (P = .004, P = .002), 11 blade (P = .007, P = .023), and 15 blade (P = .010, P = .003), respectively. CONCLUSION Microscalpel incisions result in less inflammation and increased tensile strength compared with electrocautery and higher tensile strength compared to the 15 blade in the rat model. Inflammation scores were equivocal between the microscalpel, 11 blade, and 15 blade. Our findings support the use of the microscalpel blade for facial plastic and reconstructive procedures. Prospective, randomized human studies are warranted.
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Affiliation(s)
- Elizabeth C Pearce
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph E Hall
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelli L Boyd
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard Rousseau
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - W Russell Ries
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
OBJECTIVE To describe a new craniotomic technique that eliminates burr holes and minimizes bone loss along the craniotomic line. PATIENTS AND METHODS Fifty burr hole free craniotomies were performed in varied locations using an image-guided micro-oscillating saw. Care was taken to avoid cutting the inner cortical layer. Upon completing the micro-oscillating saw cut the inner table could then be gently fractured along the craniotomic line with a thin bladed osteotome. Simple silk sutures were used to resecure the bone flap. RESULTS The craniotomic time required for this procedure ranged from 7 to 24 minutes (mean: 13 minutes). We observed no dural lacerations or signs of brain damage in any of these procedures. The use of image guidance allows a continuous measure of bone thickness along the craniotomic line. In all of the cases we report the cosmetic result was excellent. CONCLUSION This alternative technique of craniotomy can be used in selected cases to achieve excellent cosmetic results which avoid the time and cost of complex reconstruction techniques.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Istituto Nazionale Neurologico ''C. Besta'', Milan, Italy.
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Yakirevitch A, Nakache G, Lipschitz N, Alon EE, Wolf M, Talmi YP. Use of the vessel sealing system in tracheostomy. Isr Med Assoc J 2013; 15:275-276. [PMID: 23882889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Tracheostomy is a frequent, and at times semiurgent, surgical procedure. It is performed in close proximity to the thyroid gland, and in many cases requires division of its isthmus, putting a patient in danger of significant bleeding. OBJECTIVES To examine prospectively the feasibility of vessel sealing in tracheostomy. METHODS A vessel-seating device was used in 24 consecutive patients undergoing tracheostomy. There were no exclusion criteria for enrolling the patients. No other hemostatic technique was used for dividing the isthmus. RESULTS There were no bleeding events throughout the postoperative period. The operating time saving was 5-10 minutes. CONCLUSIONS Use of the vessel sealer was found to be straightforward, efficacious, rapid and safe.
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otorhinolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Papa MZ, Zbar AP, Zippel DB. Emerging new technology: are surgeons leading or being led? J Surg Oncol 2013; 107:683-4. [PMID: 23297080 DOI: 10.1002/jso.23314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/07/2012] [Indexed: 11/06/2022]
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Kranzfelder M, Staub C, Fiolka A, Schneider A, Gillen S, Wilhelm D, Friess H, Knoll A, Feussner H. Toward increased autonomy in the surgical OR: needs, requests, and expectations. Surg Endosc 2012; 27:1681-8. [PMID: 23239307 DOI: 10.1007/s00464-012-2656-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Michael Kranzfelder
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675 München, Germany.
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Olweny EO, Best SL, Tracy CR, Cadeddu JA. New technology and applied research: what the future holds for LESS and NOTES. ARCH ESP UROL 2012; 65:434-443. [PMID: 22495285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Rapid technological developments in the 1970's contributed to the emergence of operative laparoscopy as a revolution in surgery. In recent years, there has been a surge of interest in laparoendoscopic single-site (LESS) and natural orifice translumenal endoscopic surgery (NOTES), novel techniques that have the potential to further minimize the invasiveness and morbidity of surgery. Innovations in instrument design and in novel surgical platforms including robotic technology have rapidly been developed in an effort to enhance the future clinical applicability of these techniques. In this chapter, we review the current status and future directions of LESS and NOTES technology, focusing on the current research in the field.
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Affiliation(s)
- Ephrem O Olweny
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA
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Lee J. Leading-edge gadgets. ECRI unveils top 10 C-suite Watch List. Mod Healthc 2012; 42:12. [PMID: 22355920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Volkov AM, Khubulava GG, Paĭvin AA, Liubimov AI, Kravchuk VN. [Application of a device for determination of the transplant length during operation of the aorta-coronary bypass]. Vestn Khir Im I I Grek 2012; 171:64-66. [PMID: 22774554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Determination of the necessary length of the bypass is one of the principal stages of operation of the aorta-coronary bypass. The greatest difficulty of the determination of the bypass length is the first-priority applying of proximal anastomoses. It requires the surgeon to have great experience, the operation to be longer. It also makes it necessary to prepare a conduit of deliberately excessive length. A device is proposed for the determination of the necessary bypass length during operation of aorta-coronary bypass consisting of a crocodile grip with a fixed to it polymer tube.
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16
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Medvedev VA. [The methods for the treatment of combined nasal deformities]. Vestn Otorinolaringol 2012:61-64. [PMID: 23250531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to improve the cosmetic outcome of the surgical treatment of combined nasal deformities performed by the author using the rhinoplastic technique in 144 patients presenting with this condition during the period from 2006 to 2010. The patients of the main (study) group underwent the surgical intervention with the use of improved technologies proposed by the author and special instruments developed for the purpose. The patients of the control group were treated by standard surgical techniques. A statistically significant decrease of the relative frequency (percentage) of secondary nasal deformities was documented in the study group compared with the control one (from 6.94% to 2.78%). It is concluded that the technologies of rhinoplastic interventions described in the present publication can be recommended for the use in the practical work of otorhinolaryngologists and plastic surgeons.
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Rothman RH. Surgical technology international. Forward. Surg Technol Int 2010; 20:15. [PMID: 22811988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Richard H Rothman
- Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA
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18
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Udayakumaran S, Roth J, Kesler A, Constantini S. Miethke DualSwitch Valve in lumboperitoneal shunts. Acta Neurochir (Wien) 2010; 152:1793-800. [PMID: 20607315 DOI: 10.1007/s00701-010-0724-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 06/17/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the existence of wide variety of shunt systems, physiological regulation of intracranial pressure in shunted patients remains a utopian dream. Lumboperitoneal shunts (LPS) have long been used for treating idiopathic intracranial hypertension and other types of "communicating" hydrocephalus. Although they can provide rapid and effective symptom resolution, cerebrospinal fluid (CSF) over-drainage remains a common complication of LPS. We introduce the use of the Miethke DualSwitch Valve (M-DSV) for LPS and describe our preliminary experience with these valves in managing and avoiding CSF over-drainage. This is the first description of the use of M-DSV for LPS. MATERIALS AND METHODS Over 6 months, we treated five patients with LPS using M-DSV. Prior to the use of the M-DSV, four patients experienced significant over-drainage symptoms secondary to LPS. Data was collected prospectively, including preoperative details and clinical outcome. RESULTS Five patients (age range, 22 to 71 years) were operated upon. Three patients had pseudotumor cerebri, one patient had an LPS for treatment of a posterior fossa pseudomeningocele, and one had an LPS for treatment of cauda equina syndrome secondary to lumbar dural ectasia. Four patients had a history of clinical over-drainage secondary to pre-existing LPS systems. The fifth patient had an LPS revision after the previous LPS migrated. Follow-up ranged from 5 to 11 months (mean, 7.8 ± 3 months). All patients had a good outcome with immediate resolution of over-drainage symptoms and are currently asymptomatic. CONCLUSIONS The use of M-DSV in LPS is an effective alternative for avoiding posture-related over-drainage and managing patients with LPS-related over-drainage symptoms. Further experience is required to address the long-term outcome, balancing sufficient drainage while preventing over-drainage.
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Affiliation(s)
- Suhas Udayakumaran
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv University, Tel Aviv Sourasky Medical Center, Israel.
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Szabó Z, Coburg AJ, Reich H, Yamamoto M, Brem H, Harwin SF. Surgical technology international. Introduction. Surg Technol Int 2010; 20:17. [PMID: 22811989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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20
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Sukhin AI, Belilovets' OM. [Hydrostream resection of the spleen in experiment]. Klin Khir 2010:45-47. [PMID: 20825092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Experimental investigation, using apparatus for hydrostream dissection of tissues, was conducted. The expediency of application of a high pressure liquid stream while performance of spleen resection in experiment was proved. The stages of the organ capsule formation and parenchyma restoration in different terms after the operation were determined.
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21
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Khudets'kyĭ II, Kryvtsun IV, Terekhov HV, Petukhov VO, Novhorods'ka LO. [Further improvement of apparatuses for the hemostasis, processing and treatment of the infected wounds using high-temperature stream]. Klin Khir 2010:53-55. [PMID: 20825094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The bleeding stoppage and the wound sanitation constitute an important problem of modern surgery. There is information presented concerning the apparatuses elaboration for the bleeding stoppage, processing of the soft living tissues wounds, including the infected, during surgical operations conduction, using high-temperature stream of air. The data adduced about the apparatuses trial and preclinical investigations of the method, realized with their help, had confirmed a high efficacy of hemostasis and sanation effects as well as significant reduction of the wounds processing time.
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22
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Sukhin AI, Hilevych RS, Bilylovets' OM, Bocharov VP, Badakh VM. [The state and perspectives of using hydrostream technologies in surgical practice]. Klin Khir 2010:17-19. [PMID: 20734816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The work is devoted to experimental investigation and clinical application of domestic apparatus for hydrostream dissection of tissues, the schemes and principle of its working are adduced. The methods of the operations performance in experimental animals are discussed. The processes, occurring in tissues under a liquid stream action in various terms after the operation were studied. The expediency of application in abdominal surgery of a liquid stream under high pressure was noted. The results of clinical exploitation of the apparatus proposed are adduced.
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23
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Yonekawa Y. [Operative neurosurgery: personal view and historical backgrounds. 6. Positioning, instruments]. No Shinkei Geka 2010; 38:381-396. [PMID: 20387581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Important points of positioning and instruments at the time of performing microneurosurgery according to the traditional Zuerich school style were presented based on the experience of ca. 1,000 surgeries/year for around 13.5 years. Most of the instruments and equipment had been taken over from the time of Prof. Yaşargil. Positioning: Three positions, supine, knee-elbow and siting position were almost all the positions, which we have used and special mention was directed to the sitting position. Around 1/3 of our surgeries were done in the sitting position. Its indication includes lesions not only in the posterior fossa, but in the parieto-occipital region and in the cervico-thoracal region down to the Th5. Good fixation of the head with Mayfield 3-pin-fixation apparatus with the use of one pin mostly around the medial root of the mastoid process (thickness of the bone and small amount of soft tissue) is of cardinal importance and prevention of excessive flexion (with the one-finger breadth between the chin and its underlying neck), so that strangulation of the tracheal tube and the jugular venous system can be avoided and also the below mentioned jugular compression maneuver can be done effectively. Basic knowledge of prevention of air embolism was pointed out: knowledge of usual anatomical entrance sites of the air (emissary veins, diploic veins, veins entering into the venous sinuses, venous plexus around the craniocervical junction etc.), detection of the air entrance sites by jugular compression and their sealing with tissue adhesives Tissucol. Endotidal CO2 value should be above 4.0 kPk. Importance of reclination of the position in case of further falling down of the CO2 value was emphasized. Special mention was made about the patent foramen ovale as a risk of air embolism. Advantages of the sitting position in the performance of supracerebellar infratentorial/transtentorial SCIT/SCTT approach and transvertebralis dural ring approach TVDRA were emphasized and the use of linear incision was stressed at the time of performance of all these surgeries including the posterior circulation revascularization, occipital artery-posterior cerebral artery/superior cerebellar artery OA-PCA/SCA bypass and occipital artery-posterior inferior cerebellar artery OA-PICA bypass. As for the operating microscope, importance of the eyepiece-lens assembly with mouthpiece was emphasized. Appropriate selection of this system enables surgery of long duration in a comfortable and non-tiring condition in terms of the arm length of the surgeon and his immediate reaction especially at the time of intraoperative premature rupture of an aneurysm or of minute delicate focusing at the time of microvascular suturing without withdrawal of one or both hands from the operative field for handling the operating microscope. An arm rest enables secure, effective, precise and tireless performance of microsurgery in every operating position, so that the use of height an adjustable oil pressure driven arm rest was presented along with a simply height adjustable and easily movable chair. As for the bipolar coagulator pincette, the followings were discussed: more than three different lengths of byonett forceps, each of three different tip-sizes, with isolated tips, dosis and method of coagulation. Practically no need of monopolar coagulation was pointed out. Suction tube also should have different length and size according to the depth and situations. Its vacuum power should be regulated also in accordance with changing situation in every stage of surgery. The vacuum power is regulated at surgeon's request by scrub nurses or circulating nurses, so that the surgeon can concentrate only on the precise maneuver of the tip of the suction tube. For the same reason, foot pedals for the bipolar coagulator, drilling and trepanation should be stepped by other than the surgeon, so that he can concentrate on the tip the of instrument for precise maneuvering. As tissue destruction apparatus, we prefer to use CUSA to laser, as the former enables preservation of blood vessels at the time of tissue destruction and suction by appropriate power application. Besides these, the followings items were discussed: scissors (blunt tips), Lyla retractor (variously tapered tips and fixation or holding at the other peripheral end), drilling (turning direction adjustable, cutting and diamond burr) etc.
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Ferroli P, Franzini A, Messina G, Tringali G, Broggi G. Use of self-closing U-clips for dural repair in mini-invasive surgery for herniated disc. Acta Neurochir (Wien) 2008; 150:1103-5. [PMID: 18806922 DOI: 10.1007/s00701-008-0018-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 05/13/2008] [Indexed: 11/24/2022]
Abstract
OBJECT The feasibility of a new technique of dural repair (self-closing U-clips) in mini-invasive surgery for herniated disk is demonstrated in this case report. MATERIALS AND METHODS A 44-year-old male patient underwent lumbar microdiscectomy at out Institute, with subsequent dural leak as surgical complication; the dural leak re-appeared even after a second intervention in which we used muscle and dural graft and fibrin glue to repair the leak. We then decided to employ self-closing nitinol- U-clip to achieve primary dural closure. RESULTS After the intervention the patient no more presented signs or symptoms due to the unintended durotomy, and the postoperative course was uneventful. CONCLUSION Self-closing nitinol U-clips (Medtronic, Inc., Minneapolis) can be used for closing a dural tear through a mini-invasive approach that could make a conventional microsuturing technique very difficult.
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Affiliation(s)
- P Ferroli
- Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
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Kashimura H, Ogasawara K, Kubo Y, Ogawa A. Complete neck clipping of internal carotid-posterior communicating artery aneurysms using bayonet-shaped aneurysm clips: technical note. Neurol Med Chir (Tokyo) 2007; 47:282-4; discussion 284. [PMID: 17587783 DOI: 10.2176/nmc.47.282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neck clipping for internal carotid-posterior communicating artery (IC-PC) aneurysms using standard straight, angled, or curved clip may result in remnant aneurysm neck. We describe complete neck clipping of IC-PC aneurysms using a bayonet-shaped clip. The bayonet-shaped clip is applied perpendicular to the long axis of the internal carotid artery (ICA), and the blades of the clip are inserted between the aneurysm neck and the ICA. Using the clip applicator, the clip is gradually rotated counterclockwise or clockwise for left or right ICA aneurysm, respectively, so that the distal and shank portions of the clip blade are located at the aneurysm neck in the posterior communicating artery (Pcom) and ICA, respectively. As a result, the distal flexure of the clip blade fits the junction of the ICA and Pcom. This technique was used in four patients with ruptured ICA aneurysms and five patients with unruptured ICA aneurysms. Postoperative cerebral angiography demonstrated no residual aneurysm neck and preservation of the Pcom in all patients. This technique is useful for cases of IC-PC aneurysm involving the origin of the Pcom.
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Affiliation(s)
- Hiroshi Kashimura
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
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Stolz M, Aebi U, Stoffler D. Developing scanning probe–based nanodevices—stepping out of the laboratory into the clinic. Nanomedicine: Nanotechnology, Biology and Medicine 2007; 3:53-62. [PMID: 17379169 DOI: 10.1016/j.nano.2007.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 07/19/2006] [Indexed: 10/23/2022]
Abstract
This report focuses on nanotools based on the scanning force microscope (SFM) for imaging, measuring, and manipulating biological matter at the sub-micron scale. Because pathophysiological processes often occur at the (sub-) cellular scale, the SFM has opened the exciting possibility to spot diseases at a stage before they become symptomatic and cause functional impairments in the affected part of the body. Such presymptomatic detection will be key to developing effective therapies to slow or halt disease progression.
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Affiliation(s)
- Martin Stolz
- M.E. Müller Institute for Structural Biology, Biozentrum, University of Basel, Switzerland
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Abstract
OBJECTIVE To introduce a new broken pedicle screw fragment retrieval instrument, and evaluate its clinical viability and effectiveness. METHODS Following basic retrieval contrivance of broken pedicle screws described in literature, a new retrieval instrument was designed and developed; introducing its mechanism, technical components, and use. This innovative apparatus proved successful not only in saw bone and cadaver trials but in 10 clinical cases as well. RESULTS This particular unique instrument successfully retrieves broken pedicle screw fragments through original passage backing out the screw with preservation of pedicle integrity while maintaining pedicle biomechanics. No complications were observed. CONCLUSIONS With solid scientific theoretical planning and experimentation, the new retrieval instrument design proved clinical practicality and efficacy.
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Affiliation(s)
- Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China 100730
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Carlo A. New surgical instruments and sets bring sterilization challenges. Mater Manag Health Care 2006; 15:64. [PMID: 17191558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Abstract
Surgery has rapidly evolved as new technologies are adopted. With the introduction of laparoscopic surgery, patient outcomes have improved, with faster recovery from smaller incisions. In an effort to continually improve these outcomes and offer alternative options to higher risk patients, a number of investigators have proposed the concept of operating in the peritoneal space through natural orifices, obviating the need for any abdominal skin incisions. Natural orifice translumenal endoscopic surgery (NOTES) offers the same advantages as laparoscopic surgery without skin incisions, and possibly without general anesthesia. This article gives a conceptual and technical description of NOTES, discusses its challenges and potential pitfalls, reviews the early efforts at NOTES-specific device development, and predicts potential future directions of this exciting new area of surgery.
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Affiliation(s)
- Bilal M Shafi
- Biodesign Surgical Innovation Program, Department of Surgery, Stanford University School of Medicine, Stanford, California 94305, USA
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Nouri M, Rasouli M, Shafiei S, Tavasoly A, Dehpour AR, Rahimi-Movaghar V. Does abdominal aorta clamping, as a method of spinal ischemia in rats, really work? ACTA ACUST UNITED AC 2006; 66:332-3. [PMID: 16935654 DOI: 10.1016/j.surneu.2006.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 05/30/2006] [Indexed: 11/16/2022]
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Mascott CR, Sol JC, Bousquet P, Lagarrigue J, Lazorthes Y, Lauwers-Cances V. Quantification of true in vivo (application) accuracy in cranial image-guided surgery: influence of mode of patient registration. Neurosurgery 2006; 59:ONS146-56; discussion ONS146-56. [PMID: 16888546 DOI: 10.1227/01.neu.0000220089.39533.4e] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Very few studies have attempted to quantify the true (application) accuracy of image-guidance systems during craniotomy. This is, in part, because of the lack of millimetric intraoperative targets to allow such measurements. Few in vivo studies have compared the influence of mode of patient registration on subsequent true accuracy. METHODS Seven modes of patient registration (anatomic landmarks, 5 or 10 adhesive fiducials, bone-implanted fiducials [Stryker-Leibinger], surface matching using 45 or 100 points over scalp convexity or nose/auditory meatus contours) were compared. Thirty patients were involved in the study. Millimetric targets (bone drill holes or deep 1-mm titanium hemoclips) were placed then localized and saved at surgery. These targets were then identified on postoperative volumetric computed tomography fused with operative data sets. Localization errors of the targets were measured for each registration on an optical image-guidance system (StealthStation). RESULTS Only implanted cranial fiducials had a statistically significant accuracy advantage (1.7 +/- 0.7 mm). All other registrations had similar accuracies (approximately 4.0 +/- 1.7 mm) except anatomic landmarks, which were worse (4.8 +/- 1.9 mm). Calculated accuracies (root mean squared) had no predictive value for true (application) accuracies. CONCLUSION Not surprisingly, application accuracy of image-guidance is worse without implanted cranial markers. Unexpectedly, there was no major difference in localization of deep targets between the other registrations tested in this study. Care must be taken when using image-guidance tools to consider error introduced by registration. Cranium-implanted fiducials should be considered when high accuracy and reproducibility are needed.
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Affiliation(s)
- Christopher R Mascott
- Department of Neurosurgery, Toulouse University Hospitals, Toulouse-Rangueil, France.
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Boström S, Bobinski L, Zsigmond P, Nilsson I, Theodorsson A. A new scaled microgauge for use in neurosurgery. Acta Neurochir (Wien) 2005; 147:1281-2; discussion 1282. [PMID: 16133769 DOI: 10.1007/s00701-005-0620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A new scaled microgauge is described for measuring anatomical structures during microsurgery. The instrument has a tip marked in millimetres, which can be positioned in any desired angle enabling measurement in confined areas.
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Affiliation(s)
- S Boström
- Department of Neurosurgery, University Hospital, Linköping, Sweden
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Abstract
New educational concepts and tools are being developed to remodel surgical education. This is, in part, being driven by changes in the public's expectations of our profession along with new students seeking a different model of education. The explosion of new surgical procedures and technologies has amplified the importance of remodelling how we teach and train. At the heart of any educational experience should be a curriculum that is flexible enough to change with the content and educational tools available, but robust enough to deliver to the trainee the skills and foundation they need to safely and efficiently move through the complex medical education system that is evolving worldwide today. Here, we describe such a curriculum with great future promise to meet these expectations.
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Affiliation(s)
- C Daniel Smith
- Emory Endosurgery Unit and Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Abstract
The bipolar scissors, coblator, harmonic scalpel, and somnoplasty techniques are widely available and offer new choices for the operating arena. There are advantages and disadvantages to all four techniques. With time, these dissection methods will prove their lasting power. Otolaryngologists have already begun to expand their applications and will surely play a role in their use and development.
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Affiliation(s)
- Thomas Carroll
- Department of Otolaryngology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B 205, Denver, CO 80262, USA.
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Affiliation(s)
- J P Windfuhr
- Klinik für Hals-, Nasen-, Ohren-Krankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser-Krankenhaus St. Anna, Duisburg.
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Abstract
Coil embolization is a treatment for intracranial aneurysms with a particular appeal for posterior circulation aneurysms. However, although this procedure is effective in well-selected intracranial aneurysms, it has a series of limitations that may be overlooked as a result of its rapid technological evolution and its minimally invasive appearance. The author analyses the data that lead him to consider that since the introduction of coil embolisation in 1991 and its progressive diffusion, the technique of surgical clipping risks being underused as a therapeutic procedure for intracranial aneurysms because of the shortage of vascular neurosurgeons trained and experienced in its use.
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Affiliation(s)
- C Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Duarte G, Coltro PS, Bedone RV, Nogueira AA, Gelonezzi GM, Franco LJ. Trends in the modes of delivery and their impact on perinatal mortality rates. Rev Saude Publica 2004; 38:379-84. [PMID: 15243667 DOI: 10.1590/s0034-89102004000300007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. METHODS A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. RESULTS Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0 per thousand), early neonatal mortality (from 30.6 to 9.0 per thousand), and perinatal mortality (from 56.4 to 19.3 per thousand). CONCLUSIONS The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.
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Affiliation(s)
- Geraldo Duarte
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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Zeebregts CJ, Kirsch WM, van den Dungen JJ, van Schilfgaarde R, Zhu YH. Evolution of staples and clips for vascular anastomoses. Int Surg 2004; 89:152-60. [PMID: 15521252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Because of the development of less invasive surgical techniques, there is an increasing demand for vascular anastomosing techniques that require less exposure of the operating field. This paper reviews the most important representatives of staples, clips, and other mechanical devices for vascular anastomosing described over the last five decades. This report is organized in three parts: (1) the history of clipping and stapling devices, (2) development of the Vessel Closure System (VCS) clips, and (3) current and potential status of mechanical vascular anastomotic devices. A Medline literature search was conducted and publications on the use of staples and/or clips for the creation of vascular anastomoses identified with extensive cross-referencing. The first literature description of a mechanical vascular stapling device was by Gudov in 1950. This and other reports from the Soviet Union stimulated brisk, competitive development of vascular anastomotic devices in Europe, North America, and Japan. Fasteners included staples, penetrating pin-rings, or toothed stainless steel clips, none of which gained acceptance because of their complexity and inability to facilitate end-to-side anastomoses. A more convenient and less traumatic anastomotic system (VCS Clip applier system) was introduced into clinical practice in 1995. This system differs from staples in that it is non-penetrating. A wide variety of reports have described the advantages, both technical and biological, that clips provide over conventional needle-and-suture, particularly for the construction of vascular access for hemodialysis. A steady evolution of mechanical vascular anastomotic devices has sought to eliminate the technical and biological disadvantages of conventional suturing. Although the conventional hand-sewn, overcast non-absorbable suture remains the "gold" standard, newer techniques such as the non-penetrating arcuate-legged VCS clips are gaining acceptance as a useful addition to the vascular surgeons' armamentarium.
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Affiliation(s)
- Clark J Zeebregts
- Department of Surgery, University Hospital Groningen, Groningen, The Netherlands.
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Abstract
There are a number of new therapeutic options generated by the biotechnology, bioengineering, and bioimaging revolutions in terms of organ-specific designer drugs, genetically engineered cells, cell-specific proteins and drugs, directed energy instruments, therapeutic microdevices, etc. Many of these new therapies need to be placed exactly on, within, or adjacent to an organ, and many others are delivered by endoluminal or endovascular approaches. The common requirements are (1) the accurate delivery of the modality and (2) the functional importance of targeting the biologic basis rather than the anatomic structure--hence the term biosurgery. As more of these therapies achieve clinical applicability and FDA approval, there will be the need for the precision of delivery to be at the micro- and nanoscale, which is well beyond human physical limitations. The surgeon of the future must be able to identify those therapeutic modalities that would benefit from such exact placement or implantation and acquire the skills, training, and equipment to use surgical expertise to deliver these new modalities. A review of some of the emerging opportunities is presented. Ignoring these challenges will relinquish these new procedures to other nonsurgical interventionalists, perhaps to the detriment of patient safety.
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Affiliation(s)
- R M Satava
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Seatle, WA 98195, USA.
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Abstract
As the quality of ureteroscopy continues to improve, ancillary instrumentation will advance. The endourologist now has a vast supply of specially designed guidewires, stents, balloons, and baskets. These technologies have expanded the realm of cases that may be managed endoscopically. As the urologist becomes more familiar with the options at his or her disposal, patient care will improve.
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Affiliation(s)
- Bradley H Rosenberg
- Department of Urology, Wayne State University School of Medicine, 4160 John R, Suite 1017, Detroit, MI 48201, USA
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Ogden N. FDA regulation of technology and surgical devices in the operating room. Surg Innov 2003; 10:115-9. [PMID: 14551653 DOI: 10.1177/107155170301000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Federal regulation of medical devices began in 1976 with the signing of the Medical Device Amendments to the Food, Drug and Cosmetic Act. For the purpose of regulating medical devices, the Food and Drug Administration is divided into various divisions and branches, including the Office of Device Evaluation. The evolution of the Food and Drug Administration's regulations of laparoscopic devices is described. Also described is the technology of laparoscopic surgical devices and how they are regulated by the Office of Device Evaluation. Trends towards the future of laparoscopic devices, and their regulation, are reviewed.
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Affiliation(s)
- Neil Ogden
- General Surgery Devices Branch (GSDB),Division of General, Restorative and Neurological Devices,Office of Device Evaluation (ODE),Center for Devices and Radiological Health,Food and Drug Administration, Rockville, Maryland, USA.
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Ajmani D. Stats. Instruments of growth. Mater Manag Health Care 2003; 12:36. [PMID: 14606425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Lin E, Gonzalez R, Venkatesh KR, Mattar SG, Bowers SP, Fugate KM, Heffron TG, Smith CD. Can current technology be integrated to facilitate laparoscopic living donor hepatectomy? Surg Endosc 2003; 17:750-3. [PMID: 12616391 DOI: 10.1007/s00464-002-8858-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2002] [Accepted: 10/22/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND Living donor hepatectomy (LDH) is a technically demanding procedure that is an alternative for providing livers for transplantation. Unlike liver resections for other pathology, LDH requires preservation of the major vessels and biliary tree. This study was performed to determine if current technology can be integrated to perform laparoscopic LDH. METHODS Six adult sheep underwent laparoscopic LDH of the left lateral segment under general anesthesia. Instruments utilized included standard dissecting instruments, ultrasound, ultrasonic dissectors, CUSA, the TissueLink Floating Ball, and endoscopic staplers. RESULTS LDH-harvested liver grafts were 44% of whole liver weight. Estimated blood loss was 300 cc. Warm ischemia time was 5-7 min. Grafts were delivered through 18-cm abdominal wounds. Major vessels and biliary anatomy were positively identified in the grafts. CONCLUSIONS Laparoscopic LDH can be performed with available technology. Theoretical advantages include reduced liver manipulation and smaller wound size.
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Affiliation(s)
- E Lin
- Endosurgery Unit, Emory University Hospital, H124, 1364 Clifton Road, NE, Atlanta, GA 30322, USA
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van Veelen MA, Meijer DW, Uijttewaal I, Goossens RHM, Snijders CJ, Kazemier G. Improvement of the laparoscopic needle holder based on new ergonomic guidelines. Surg Endosc 2003; 17:699-703. [PMID: 12616397 DOI: 10.1007/s00464-002-9186-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Accepted: 10/17/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study is to create new ergonomic guidelines for the design of laparoscopic needle holders. METHODS An ergonomic literature study, observations in the operating room, handle-shaft angle measurements, and anthropometric data were used to compile new ergonomic criteria, specified to the function of a laparoscopic needle holder. Based on these guidelines a new needle holder was designed. The prototype and three currently available needle holders were evaluated according to the new guidelines. In addition, a pelvi-trainer test was done to measure the extreme wrist excursions. RESULTS The ergonomic evaluation of three commonly used handles and the new prototype indicate that the new handle is an ergonomic improvement in the field of laparoscopic needle holders: only the new handle satisfies all criteria. This is validated by the results of the pelvi-trainer test, which showed that the new prototype significantly (p <0.001) reduced the extreme wrist excursions. CONCLUSION The new design guidelines for a laparoscopic needle holder result in an ergonomic improvement of the instrument.
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Affiliation(s)
- M A van Veelen
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands.
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Ohdaira T, Nagai H, Shoji M. Intraoperative localization of colorectal tumors in the early stages using a magnetic marking clip detector system (MMCDS). Surg Endosc 2003; 17:692-5. [PMID: 12618945 DOI: 10.1007/s00464-002-8597-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2002] [Accepted: 11/21/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the laparoscopic surgical treatment of early stage colorectal carcinomas, intraoperative tumor site identification is often difficult. We developed a novel marking method using a magnetic marking clip and a modified magnetometer system. METHODS We applied magnetic marking clips at the tumor site during preoperative colonoscopy and identified the clip site with a magnetic marking clip detector system (MMCDS) of our design. Eleven patients who underwent laparoscopic colectomy were studied. RESULTS In a basic ex vivo study, magnetic bodies of more than 300 mT magnetic force were easily detected with a 100% detection ratio. In a clinical study, the marking site was detected in all 11 patients. The mean length between the detected site and clip along the longitudinal bowel axis was 14.1 mm (SD 5.6). The mean detection time was 2.4 min (SD 0.2). CONCLUSION MMCDS accurately identifies tumor sites. This method may be useful for tumor site identification during laparoscopic colectomy.
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Affiliation(s)
- T Ohdaira
- Department of Surgery, Jichi Medical School, 3311-1, Yakushiji, Minamikawachi-machi, Kawachi-gun, Tochigi-ken, Japan.
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Ludvig N, Kovacs L, Kando L, Medveczky G, Tang HM, Eberle LP, Lemon CR. The use of a remote-controlled minivalve, carried by freely moving animals on their head, to achieve instant pharmacological effects in intracerebral drug-perfusion studies. Brain Res Brain Res Protoc 2002; 9:23-31. [PMID: 11852267 DOI: 10.1016/s1385-299x(01)00133-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intracerebral drug-perfusion studies in animals can be very efficiently performed with the 'reverse-dialysis' procedure. In this procedure, drugs are delivered into the brain via an intracerebrally implanted microdialysis probe. Traditionally, in reverse-dialysis studies the flow of control and drug solutions in the microdialysis site is alternated by large and heavy valves placed far from the experimental animal. In this arrangement, the drugs travel from the fluid-alternating device for a long (20--60 min) period before reaching the brain. This can obscure the onset of drug action, makes it difficult to deliver drugs into the extracellular space during short-lasting behavioral episodes, and considerably limits the number of drug solutions that can be perfused within an experimental session. This report describes the use of a miniature (15 mm long and 8 mm diameter), lightweight (1.4 g) minivalve (patent pending) for combined neuronal recording--intracerebral microdialysis studies in freely moving rats. The device is activated remotely and carried by the animals on their head. This allows the experimenter to alternate the control and drug solutions in the intracerebral recording/dialysis site rapidly and to detect the drug-induced neuronal firing pattern changes instantly, without interfering with the animal's behavior. It is demonstrated that with this novel device the onset of drug actions on hippocampal neurons can be clearly defined and that these actions occur within 2 min after minivalve activation. Furthermore, it is demonstrated that the minivalve allows one to test a large number of drug solutions, successively, within the same experimental session. The described protocol offers a high-throughput method for testing the neuron-specific pharmacological effects of intracerebrally perfused drugs during various behaviors.
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Affiliation(s)
- Nandor Ludvig
- Department of Physiology and Pharmacology, State University of New York Downstate Medical Center, Box 31, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
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Gossot D, Validire P, Matsumoto S, Tokumura H, Shimomura K, Flowers J, Borenstein N, Daniel P. Development of an ultrasonically activated trocar system. Surg Endosc 2002; 16:210-4. [PMID: 11961642 DOI: 10.1007/s00464-001-9080-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2001] [Accepted: 06/27/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although rare, visceral and vascular injuries related to the insertion of conventional laparoscopic trocars may have disastrous consequences. Most of these injuries are due to the high puncture force applied to the trocar. We present the results of an animal laboratory evaluation of a newly developed ultrasonically activated trocar. METHODS A total of 40 punctures were made in four pigs with an average weight of 53 kg. An 11-mmHg pneumoperitoneum was created through a Veress needle. A 10-mm diameter trocar was inserted in the midline for a laparoscope. A series of five trocars were then inserted on each lateral wall under laparoscopic control. Twenty punctures were made with a conventional reusable 11-mm trocar (CT) whose tip was sharp and conical. Twenty punctures were made with an 11-mm ultrasonically activated trocar (UT), whose fequency was 23.5 KHz and amplitude 150 mm. The cutaneous incision was made large enough so that the skin did not interfere with the trocar insertion. The force applied to the trocar was measured with a push-pull gauge connected to a computer. The following data were recorded: maximal force applied to the trocar to obtain insertion of the tip through the abdominal wall, maximum abdominal pressure increase during trocar insertion, and time for abdominal penetration. RESULTS The average time needed for trocar penetration was 12.8 s with CT and 4.5 s with UT (p < 0.001). The average maximal force was 6.8 kgF with CT and 0.4 kgF with UT (p < 0.001). The average abdominal pressure increase was 7.6 mmHg with CT and 0.8 mmHg with UT (p < 0.001). At 30 days, no necrosis was found. Pathological findings were similar in both groups. CONCLUSION Ultrasonically activated trocars required less time and much less force to be inserted. This may be a breakthrough in the safety of trocar insertion.
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Affiliation(s)
- D Gossot
- Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
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Veelen MA, Meijer DW, Goossens RHM, Snijders CJ, Jakimowicz JJ. Improved usability of a new handle design for laparoscopic dissection forceps. Surg Endosc 2002; 16:201-7. [PMID: 11961640 DOI: 10.1007/s004640090102] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2000] [Accepted: 07/02/2001] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have shown that the shape of most instrument handles causes user discomfort and that none of the handles currently available on the market satisfies all ergonomic criteria. Therefore, we designed a handle with improved usability; i.e., it is easier to manipulate and its use entails less risk of injury for the operator. The aim of this study was to demonstrate that the intended improvements of the new design were successful. METHODS Six handles representative of the types that are currently available were compared with the new version. Eight surgeons used the seven handles during a precision task and a rough task in a pelvi-trainer. A questionnaire and video analyses were used to assess the usability of the handles. RESULTS Based on the responses to the questionnaire, we determined that there were significant differences between the new handle and the Aesculap handle (means of rotation and angle between handle and shaft). No significant differences were found between the new handle and the five other handles. The video analyses (documenting extreme vs neutral wrist excursions) showed significant differences between the new handle and the six other handles. CONCLUSION Compared to the six existing handles, the new handle has significantly improved usability; in particular, its hinged design obviates the need to make extreme wrist excursions.
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Affiliation(s)
- M A Veelen
- Faculty of Design, Engineering, and Production, Subfaculty of Industrial Design Engineering, Delft University of Technology, Jaffalaan 9, 2628 BX, Delft, The Netherlands.
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Lee DW, Chan AC, Lam YH, Wong SK, Ng EK, Law BK, Chung SC. Subfascial endoscopic perforator vein surgery (SEPS) using the ultrasonic scalpel. Surg Endosc 2001; 15:1491-3. [PMID: 11965479 DOI: 10.1007/s004640000370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/1999] [Accepted: 09/01/2000] [Indexed: 11/29/2022]
Abstract
Subfascial endoscopic perforator vein surgery (SEPS) was recently introduced as a minimally invasive method to ligate incompetent perforating veins in patients with severe chronic venous insufficiency of the lower extremities. Herein we describe a technique in which we used a 5-mm ultrasonic scalpel for the transection of perforating veins in 16 SEPS performed in 14 patients. The use of the ultrasonic scalpel allowed for the precise coagulation and transection of the perforator vein with hemostasis, while avoiding the use of metal clips. Our initial results showed that the technique was feasible with minimal morbidity. We recommend the use of the ultrasonic scalpel as an alternative tool to transect perforating veins in SEPS.
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Affiliation(s)
- D W Lee
- Department of Surgery, Prince of Wales Hospital, The Chinese University of HongKong, Shatin, N. T., Hong Kong
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