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Maxillofacial Plastic and... Feb 2023
PubMed: 36800048
DOI: 10.1186/s40902-023-00376-8 -
JBJS Essential Surgical Techniques 2022Various techniques for periacetabular osteotomy have been reported to prevent the progression of osteoarthritis in dysplastic hips. Bernese periacetabular osteotomy,...
UNLABELLED
Various techniques for periacetabular osteotomy have been reported to prevent the progression of osteoarthritis in dysplastic hips. Bernese periacetabular osteotomy, which involves the use of an anterior approach, is widely performed throughout the world because it offers preservation of the blood supply to the bone fragment and lateral pelvic muscles. However, Bernese periacetabular osteotomy has potential complications, such as nonunion at the osteotomy site, postoperative fracture, nonunion of the pubis and ischium, and damage to the main trunk of the obturator artery. Spherical periacetabular osteotomy (SPO) has been developed to resolve some of disadvantages of Bernese periacetabular osteotomy. Although SPO involves some technical difficulty, the procedure is safe when performed with use of appropriate preoperative 3-dimensional planning and surgical technique.
DESCRIPTION
Preoperative 3-dimensional planning is utilized to decide the radius of the curved osteotome, locations of the reference points for the osteotomy line, and depth of the bone groove at the teardrop area. The pelvic positioning is arranged fluoroscopically to match the neutral position based on preoperative planning. A 7-cm incision is made along the medial margin of the iliac crest. An anterior iliac crest osteotomy of 4.5 cm (length) × 1 cm (medial wedge-shaped) is performed. The operative field is maintained with aluminum retractors. The osteotomy line is completed by connecting the preoperatively planned reference points on the inner cortex of the ilium. The bone groove is made along the osteotomy line with use of a high-speed burr. A blunt osteotome is inserted into the bone groove at the teardrop area until it reaches the preoperatively planned depth. The blunt osteotome makes a pathway for the curved osteotome without breaking the quadrilateral surface (QLS) or perforating the hip joint. The special curved osteotome is inserted manually until it reaches the bottom of the groove, and the posterior cortex is cut. After the top of the teardrop is divided fluoroscopically, the anterior ischial cortex is osteotomized with a sharpened spiked Cobb elevator at the infracotyloid groove. An angled curved osteotome is used for the osteotomy of the superior area of the teardrop area. The bone fragment is rotated with a spreader and an angled retractor, and fixed with 2 absorbable screws. Beta-tricalcium phosphate blocks are inserted into the bone gap. The osteotomized wedge-shaped iliac bone is repositioned and fixed.
ALTERNATIVES
Alternatives include the Bernese periacetabular osteotomy, rotational acetabular osteotomy, and triple innominate osteotomy.
RATIONALE
Bernese periacetabular osteotomy utilizes an anterior approach, cuts into the QLS, and preserves the posterior column. In contrast, SPO preserves the QLS and does not cut the pubis. These features of SPO have some advantages. The large osteotomized surface is advantageous for osseous fusion, and preserving the QLS and pubis protects the trunk of the obturator artery. Furthermore, the preservation of the connection between the ilium, ischium, and pubis in SPO maintains a more stable pelvic ring than in Bernese periacetabular osteotomy. The osteotomy line is arranged to prevent leg shortening caused by thin medial bone stock of the bone fragment. Although splitting the teardrop area in SPO is somewhat technically difficult, particularly in cases with a thin teardrop, it can be safely done with use of preoperative 3-dimensional planning and appropriate surgical technique.In addition, the use of our medial wedge-shaped osteotomy at the iliac crest has 2 advantages: protection of the lateral femoral cutaneous nerve and preservation of the attachment of the tensor fascia latae muscle.
EXPECTED OUTCOMES
The advantages of SPO are a stable pelvic ring postoperatively, reduced risk of nonunion at the osteotomy site, no risk to the trunk of the obturator artery, preservation of the blood supply to the bone fragment, a small incision, and early muscle recovery.
IMPORTANT TIPS
Preoperative 3-dimensional planning of the osteotomy design is essential.The special curved osteotomes are designed so that osteotomy of the posterior cortex is completed when the handles are perpendicular to the pelvis.The special curved osteotomes are made with a radius of either 50 or 60 mm, which are the most suitable sizes for the Japanese population. Larger-diameter osteotomes may be required for different races.As the rotated bone fragment is relatively small, it is difficult to obtain rigid fixation of the osteotomy site. Hence, the fragment can move slightly in the early phase after surgery. Careful rehabilitation is needed.
ACRONYMS AND ABBREVIATIONS
AIIS = anterior inferior iliac spineASIS = anterior superior iliac spineLFCN = lateral femoral cutaneous nerveG.T. = greater trochanterK-wire = Kirschner wireBeta (β)-TCP = beta-tricalcium phosphate.
PubMed: 36816525
DOI: 10.2106/JBJS.ST.21.00048 -
Indian Journal of Thoracic and... Apr 2019Placing retractor and stabilization devices during open heart surgery can be difficult in obese patients due to extremely short neck and excessive breast tissue....
Placing retractor and stabilization devices during open heart surgery can be difficult in obese patients due to extremely short neck and excessive breast tissue. Off-pump coronary bypass operations in these patients can be particularly technically demanding. To overcome this difficulty, we have used two retractors concomitantly. The first retractor is placed to the edges of sternum and the second one is placed into this first retractor. This maneuver ensures an extra height, and placing stabilization devices in this second retractor is relatively easy. Thus, we suggest that adding this maneuver will facilitate off-pump coronary bypass operations.
PubMed: 33061024
DOI: 10.1007/s12055-019-00799-x -
Missouri Medicine 2024The landscape of the cranial neurosurgery has changed tremendously in past couple of decades. The main frontiers including introduction of neuro-endoscopy, minimally... (Review)
Review
The landscape of the cranial neurosurgery has changed tremendously in past couple of decades. The main frontiers including introduction of neuro-endoscopy, minimally invasive skull base approaches, SRS, laser interstitial thermal therapy and use of tubular retractors have revolutionized the management of intracerebral hemorrhages, deep seated tumors other intracranial pathologies. Introduction of these novel techniques is based on smaller incisions with maximal operative corridors, decreased blood loss, shorter hospital stays, decreased post-operative pain and cosmetically appealing scars that improves patient satisfaction and clinical outcomes. The sophisticated tools like neuroendoscopy have improved light source, and better visualization around the corners. Advanced navigated tools and channel-based retractors help us to target deeply seated lesions with increased precision and minimal disruption of the surrounding neurovascular tissues. Advent of stereotactic radiosurgery has provided us alternative feasible, safe and effective options for treatment of patients who are otherwise not medically stable to undergo complex cranial surgical interventions. This paper review advances in treatment of intracranial pathologies, and how the neurosurgeons and other medical providers at the University of Missouri-Columbia (UMC) are optimizing these treatments for their patients.
Topics: Humans; Neurosurgical Procedures; Radiosurgery; Cerebral Hemorrhage; Brain Neoplasms; Neuroendoscopy
PubMed: 38694609
DOI: No ID Found -
Surgery Journal (New York, N.Y.) Apr 2020Surgical performance in the operating room (OR) is supported by effective illumination, which mitigates the inherent environmental, operational, and visual challenges... (Review)
Review
Surgical performance in the operating room (OR) is supported by effective illumination, which mitigates the inherent environmental, operational, and visual challenges associated with surgery. Three critical components are essential to optimize operating light as illumination: (1) centering on the surgeon's immediate field, (2) illuminating a wide or narrow field with high-intensity light, and (3) penetrating into a cavity or under a flap. Furthermore, optimal surgical illumination reduces shadow, glare, and artifact in visualization of the surgical site. However, achieving these principles is more complex than at first glance, requiring a detailed examination of the variables that comprise surgical illumination. In brief, efficacious surgical illumination combines sufficient ambient light with the ability to apply focused light at specific operative stages and angles. But, brighter is not always merely better; rather, a nuanced approach, cognizant of the challenges inherent in the OR theater, can provide for a thoughtful exploration of how surgical illumination can be utilized to the best of its ability, ensuring a safe and smooth surgery for all.
PubMed: 32577527
DOI: 10.1055/s-0040-1710529 -
Journal of Minimally Invasive Surgery Sep 2021Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic...
PURPOSE
Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single port at the umbilicus and using the abdominal wall-lifting method, without establishing pneumoperitoneum.
METHODS
Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection.
RESULTS
The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m. The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups.
CONCLUSION
The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.
PubMed: 35600100
DOI: 10.7602/jmis.2021.24.3.152 -
Robotic Surgery (Auckland) 2019There has been rapid growth in the utilization of robotic surgery in the head and neck. Its utilization in the phonosurgical space has lagged owing to difficulty with... (Review)
Review
There has been rapid growth in the utilization of robotic surgery in the head and neck. Its utilization in the phonosurgical space has lagged owing to difficulty with access and exposure to the laryngeal site, small working space due to the size of the larynx and the need to work around an endotracheal tube. The goal of this work is to explore recent developments in robotic microlaryngeal surgery. At this time robotic instrumentation is available; however, the range of instruments is not as extensive to match the current microlaryngeal instrumentation that exists for traditional endoscopic surgery. Studies have demonstrated the ability to perform phonosurgery safely with currently available robotic systems but exposure is less than ideal. Work is been undertaken to develop specialized transoral robotic retractors which will improve visualization and allow the robotic instrument to reach the glottis, which has traditionally been the most difficult to area to access. Additional studies will be needed to assess the application of these systems to more patient populations, and prospective research will be required to compare outcomes of traditional phonosurgery to robotic phonosurgery.
PubMed: 31750363
DOI: 10.2147/RSRR.S177698 -
EFORT Open Reviews Jun 2019Glenoid exposure should offer frontal access to the glenoid to allow the ancillary tools to be used freely and thus facilitate the good positioning of the glenoid... (Review)
Review
Glenoid exposure should offer frontal access to the glenoid to allow the ancillary tools to be used freely and thus facilitate the good positioning of the glenoid implant.The two classically recognized approaches for shoulder arthroplasty are the deltopectoral and the transdeltoid approach.The axillary nerve is the most important anatomical structure in the glenoid, passing down the anterior part of the subscapularis, the inferior pole of the joint and the deep face of the deltoid muscle.Inferior glenohumeral release is the key step that allows the humerus to be retracted back or downwards thereby exposing the glenoid face on.In difficult and stiff cases, once pectoralis major release, osteophyte resection and posterior capsulectomy have been performed, a compression fracture, produced by using a retractor to push against the upper extremity of the humerus, can provide the extra few millimetres of space required to use the ancillary tools without hindrance. Cite this article: 2019;4 DOI: 10.1302/2058-5241.4.180057.
PubMed: 31312516
DOI: 10.1302/2058-5241.4.180057