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The Journal of Hand Surgery Sep 2020The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and... (Review)
Review
The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.
Topics: Adult; Amputation, Traumatic; Betacoronavirus; COVID-19; Coronavirus Infections; Emergency Treatment; Finger Injuries; Humans; Male; Microsurgery; Pandemics; Pneumonia, Viral; Plastic Surgery Procedures; SARS-CoV-2
PubMed: 32888437
DOI: 10.1016/j.jhsa.2020.07.013 -
Asian Journal of Andrology 2016Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the... (Review)
Review
Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the repairs had been mostly for the treatment of male infertility. However, the diagnosis and treatment of varicoceles were controversial, because the pathophysiology was not clear, the entry criteria of the studies varied among centers, and there were few randomized clinical trials. Nevertheless, clinicians continued developing techniques for the correction of varicoceles, basic scientists continued investigations on the pathophysiology of varicoceles, and new outcome data from prospective randomized trials have appeared in the world's literature. Therefore, this special edition of the Asian Journal of Andrology was proposed to report much of the new information related to varicoceles and, as a specific part of this project, the present article was developed as a comprehensive review of the evolution and refinements of the corrective procedures.
Topics: History, 20th Century; Humans; Male; Microsurgery; Spermatic Cord; Varicocele
PubMed: 26732111
DOI: 10.4103/1008-682X.170866 -
Orthopaedics & Traumatology, Surgery &... Jun 2020In France, microsurgery is taught in University diploma courses, for a mean 100hours (range, 45-120hours) extending over several months. This training, spread over the...
INTRODUCTION
In France, microsurgery is taught in University diploma courses, for a mean 100hours (range, 45-120hours) extending over several months. This training, spread over the year, encounters problems of maintaining high-quality supervision and enduring acquisition of skills. These difficulties risk leading to withdrawal of certain courses, already suffering from funding issues and administrative requirements for animal welfare.
MATERIAL AND METHOD
We report our experience with a 2-week module comprising nine 4-hour sessions (total, 36hours), with continuous supervision of 5 students in each of 2 groups (10 students), enabling personalized learning. At the end of each session, an assessment questionnaire was filled out by teachers and students.
RESULTS
Students' scores increased from a mean 23.9/30 points (range, 20 - 30) at session 3 to 26.9 points (range, 23 - 30) at session 9 (p=0.012). At the end of session 3, students were grouped as good, average or beginners, based on the first assessments: i.e., with differences in level between groups at session 3. At the end of session 9, all 3 groups showed statistically comparable levels. Comparison between student and teacher questionnaire responses showed a significant discrepancy in 7 of the 10 cases in week 1, and no significant discrepancy in 7 of the 10 cases by the end of week 2.
DISCUSSION
The efficacy of condensed learning is based on immediate repetition of exercises, following Ebbinghaus: without repetition, memory decays exponentially, whereas if the information is rapidly repeated, the curve flattens and memory is consolidated. The present rapid improvement in the acquisition of the principles of microsurgery stimulated the enthusiasm of both students and teachers for what is reputed to be a demanding type of training. The study showed that acquisition, assessed in terms of vascular suture reliability, was achieved by the end of a 36-hour module, regardless of the student's baseline level.
Topics: France; Humans; Learning; Microsurgery; Reproducibility of Results
PubMed: 32359954
DOI: 10.1016/j.otsr.2020.02.009 -
Microsurgery May 2021
Microsurgery training during COVID-19 pandemic: Practical recommendations from the International Society for Experimental Microsurgery and International Microsurgery Simulation Society.
Topics: Animals; COVID-19; Humans; Microsurgery; Pandemics; Simulation Training
PubMed: 33606305
DOI: 10.1002/micr.30725 -
European Review For Medical and... May 2019Despite the improvements reached by microsurgeons in the last 30 years, postoperative complications still occur and most of them are the result of venous thrombosis at... (Review)
Review
OBJECTIVE
Despite the improvements reached by microsurgeons in the last 30 years, postoperative complications still occur and most of them are the result of venous thrombosis at the pedicle anastomosis. Primary prevention of thrombosis is mandatory and anticoagulant therapy in the preoperative and postoperative period is widely used. Still, there is a lack of consensus in the literature about the best postoperative protocol for microsurgical reconstruction. The authors aimed to review the postoperative antithrombotic regimens described in literature focusing on their effects and risks, and moreover, share their experience.
MATERIALS AND METHODS
The authors performed a literature review of postsurgical antithrombotic protocols applied in reconstructive microsurgery. Research on PubMed server was performed typing the terms "antithrombotic", "postoperative", "microsurgery", "free flap pedicle", "anticlotting", "anticoagulant".
RESULTS
The authors described the postoperative standardized pro-weight pharmacological protocol applied in their unit: a combination of dextran and heparin. They inhibit more than one pattern of coagulation in order to stop platelet aggregation and thrombin action and, in the meantime, contending fluid loss with plasma expansion.
CONCLUSIONS
Nowadays, a non-standardized practice, based on experience, is applied by microsurgeons in postsurgical care; the authors performed a review of the combined antithrombotic therapies described in the literature. A standardized pro-weight pharmacological protocol is proposed; it allows to increase blood flow by volume expander action (Dextran) and thrombin inhibition (Heparin). Still, coagulation cascade and platelet function have a wide variability among humans, as well as the effect of drugs. Achieving an optimal antithrombotic effect and minimizing adverse reactions meantime remains a challenge.
Topics: Fibrinolytic Agents; Humans; Microsurgery; Postoperative Care; Postoperative Complications
PubMed: 31173322
DOI: 10.26355/eurrev_201905_17955 -
Ugeskrift For Laeger Jun 2016Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of... (Review)
Review
Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of microsurgery which evolved during the 1960s. Microsurgery in hand surgery is primarily replantation and revascularisation but also peripheral nerve surgery as well as brachial plexus surgery. Lymphoedema is being treated with super microsurgery on an experimental basis. Dynamic reconstruction of facial palsy is performed in a two-stage operation with cross-over nerve graft and a free microvascular muscle flap, typically gracilis.
Topics: Brachial Plexus; Denmark; Facial Paralysis; Hand Injuries; History, 20th Century; Humans; Lymphedema; Microsurgery; Peripheral Nervous System
PubMed: 27292577
DOI: No ID Found -
Journal of Neurosurgical Sciences Mar 2016The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the... (Review)
Review
The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms.
Topics: History, 20th Century; History, 21st Century; Humans; Intracranial Aneurysm; Microsurgery; Neurosurgical Procedures; Surgical Instruments; Vascular Surgical Procedures
PubMed: 26657306
DOI: No ID Found -
Laryngo- Rhino- Otologie May 2022Robotic systems for head and neck surgery are at different stages of technical development and clinical application. Currently, robotic systems are predominantly used... (Review)
Review
Robotic systems for head and neck surgery are at different stages of technical development and clinical application. Currently, robotic systems are predominantly used for transoral surgery of the pharynx and larynx. Robotic surgery of the neck, the thyroid, and the middle and inner ear is much less common; however, some oncological and functional outcomes have been reported. This article provides an overview of the current state of robot-assisted head and neck surgery with a special emphasis on patient benefit and postoperative quality of life (QoL). The focus is placed on the role of transoral robotic surgery (TORS) for the resection of oropharyngeal carcinomas. For this application, reported long-term outcomes show functional post-operative advantages for selected oropharyngeal cancer patients after TORS compared to open surgery and primary radiotherapy. Since TORS also plays a significant role in the context of potential therapy de-escalation for HPV-positive oropharyngeal cancer patients, ongoing trials are presented. Regarding the evaluation of the therapeutic benefit and the QoL of cancer patients, special attention has to be paid to the large degree of variability of individual patients' preferences. Influencing factors and tools for a detailed assessment of QoL parameters are therefore detailed at the beginning of this article. Notably, while some robotic systems for ear and skull base surgery are being developed in Europe, TORS systems are mainly used in North America and Asia. In Europe and Germany in particular, transoral laser microsurgery (TLM) is a well-established technology for transoral tumor resection. Future trials comparing TORS and TLM with detailed investigation of QoL parameters are therefore warranted and might contribute to identifying suitable fields for the application of the different techniques.
Topics: Humans; Microsurgery; Oropharyngeal Neoplasms; Quality of Life; Robotic Surgical Procedures; Robotics; Treatment Outcome
PubMed: 35605618
DOI: 10.1055/a-1647-8650 -
Journal of Visceral Surgery Jun 2018Peritoneal adhesions remain a major public health problem despite the development of laparoscopy. The rules of microsurgery must be known and followed during any pelvic... (Review)
Review
Peritoneal adhesions remain a major public health problem despite the development of laparoscopy. The rules of microsurgery must be known and followed during any pelvic surgery, even in patients who no longer have a desire for pregnancy. Anti-adhesion products are numerous. All have interest, confirmed by anatomical studies showing a smaller extent or a lesser severity of adhesions associated with their use. No studies, however, show clinical benefit in terms of improved pain or postoperative fertility. Pneumoperitoneum parameters, humidification, and lower abdominal pressure should be optimized to limit peritoneal trauma. Peri-operative corticosteroids, whose benefit has been has been demonstrated in at least one randomized trial, should be systematically used.
Topics: Humans; Infertility; Laparoscopy; Microsurgery; Peritoneal Diseases; Postoperative Complications; Tissue Adhesions
PubMed: 29784584
DOI: 10.1016/j.jviscsurg.2018.02.004 -
Clinical Oral Investigations Sep 2023This study was aimed at evaluating the clinical and radiological outcomes of novel dynamic navigation (DN)-aided endodontic microsurgery (EMS), with an analysis of...
OBJECTIVES
This study was aimed at evaluating the clinical and radiological outcomes of novel dynamic navigation (DN)-aided endodontic microsurgery (EMS), with an analysis of potential prognostic factors.
MATERIALS AND METHODS
Forty-six teeth from 32 patients who received DN-aided EMS were included. Clinical and radiographic assessments were performed at least 1 year postoperatively. Two calibrated endodontists assessed radiological outcomes according to two-dimensional (2D) periapical radiography (PA) and three-dimensional (3D) cone-beam computed tomography (CBCT) imaging using Rud's and Molven's criteria and modified PENN 3D criteria, respectively. Fisher's exact test was used for statistical analysis of the predisposing factors.
RESULTS
Of the 32 patients with 46 treated teeth, 28 with 40 teeth were available for follow-up. Of the 28 patients, four (five teeth) refused to undergo CBCT and only underwent clinical and PA examinations, and the remaining 24 (35 teeth) underwent clinical, PA, and CBCT examinations. Combined clinical and radiographic data revealed a 95% (38/40) success rate in 2D healing evaluations and a 94.3% (33/35) success rate in 3D healing evaluations. No significant effect was found in sex, age, tooth type, arch type, preoperative lesion volume, preoperative maximum lesion size, presence/absence of crown and post, and the root canal filling state on the outcome of DN-aided EMS.
CONCLUSIONS
DN-aided EMS has a favorable prognosis and could be considered an effective and reliable treatment strategy. Further investigations with larger sample sizes are required to confirm these results.
CLINICAL RELEVANCE
DN-aided EMS could be considered an effective and reliable treatment strategy.
Topics: Humans; Prospective Studies; Microsurgery; Tooth; Prognosis; Cone-Beam Computed Tomography; Root Canal Therapy; Treatment Outcome
PubMed: 37530891
DOI: 10.1007/s00784-023-05152-6