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International Endodontic Journal Oct 2022Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown and root... (Review)
Review
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown and root resections, surgical perforation repair and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. Whilst nonsurgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
Topics: Apicoectomy; Endodontics; Microsurgery; Retreatment; Root Canal Obturation; Root Canal Therapy; Humans
PubMed: 35670053
DOI: 10.1111/iej.13783 -
Medicina (Kaunas, Lithuania) Mar 2023: Endodontic surgery has evolved over the last two decades. The use of state-of-the-art guided endodontic surgical procedures produces a predictable outcome in the... (Review)
Review
: Endodontic surgery has evolved over the last two decades. The use of state-of-the-art guided endodontic surgical procedures produces a predictable outcome in the healing of lesions of endodontic origin. The main objective of this review paper is to define and characterize guided surgical endodontics as well as its benefits and drawbacks by reviewing the most recent relevant scientific literature. : A literature search was conducted using multiple databases comprising of MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were 'guided endodontics', 'surgical endodontics', and 'endodontic microsurgery'. : In total, 1152 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 388 articles were excluded. A total of 45 studies were finally included in the review. : Surgical-guided endodontics is a relatively new area of study that is still maturing. It has many applications such as root canal access and localization, microsurgical endodontics, endodontic retreatment, and glass fiber post removal. Additionally, it does not matter how experienced the operator is; the procedure can be completed for the patient in less time and provides greater accuracy and safety than conventional endodontics.
Topics: Humans; Root Canal Therapy; Endodontics; Microsurgery
PubMed: 37109636
DOI: 10.3390/medicina59040678 -
Journal of the Chinese Medical... May 2024Lymphedema impairs patients' function and quality of life. Currently, supermicrosurgical lymphovenous anastomosis (LVA) is regarded as a significant and effective... (Review)
Review
Lymphedema impairs patients' function and quality of life. Currently, supermicrosurgical lymphovenous anastomosis (LVA) is regarded as a significant and effective treatment for lymphedema. This article aims to review recent literature on this procedure, serving as a reference for future research and surgical advancements. Evolving since the last century, LVA has emerged as a pivotal domain within modern microsurgery. It plays a crucial role in treating lymphatic disorders. Recent literature discusses clinical imaging, surgical techniques, postoperative care, and efficacy. Combining advanced tools, precise imaging, and surgical skills, LVA provides a safer and more effective treatment option for lymphedema patients, significantly enhancing their quality of life. This procedure also presents new challenges and opportunities in the realm of microsurgery.
Topics: Humans; Anastomosis, Surgical; Lymphedema; Microsurgery; Lymphatic Vessels; Veins
PubMed: 38517403
DOI: 10.1097/JCMA.0000000000001088 -
Sensors (Basel, Switzerland) Oct 2023Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and... (Review)
Review
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
Topics: Humans; Robotics; Microsurgery; Neurosurgical Procedures; Neurosurgery; Clinical Competence
PubMed: 37896597
DOI: 10.3390/s23208503 -
World Neurosurgery Mar 2022Despite advances in endovascular techniques, microsurgery continues to play an important role in the treatment of cerebral aneurysms. This article reviews the history of... (Review)
Review
Despite advances in endovascular techniques, microsurgery continues to play an important role in the treatment of cerebral aneurysms. This article reviews the history of surgical treatment of intracranial aneurysms and the evolving role of microsurgery in the endovascular era. Although endovascular tools and techniques have changed significantly since the placement of the first Guglielmi coils in 1990, with the development of endoluminal flow-diverting stents and now endosaccular flow-diverting devices, microsurgical treatment of aneurysms has also continued to evolve. Since the first treatment with Hunterian ligation by Horsley in the 1800s, surgical treatment of intracranial aneurysms has advanced significantly beginning with the introduction of the microscope and microsurgical techniques in the 1950s. More recent advances in microsurgical treatment of aneurysms include microsurgical adjuncts, such as indocyanine green angiography, adenosine, and the exoscope, as well as tailored craniotomies, retractorless surgery, and novel bypass constructs for complex aneurysms. Microsurgery continues to play an important role in the endovascular era.
Topics: Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Microsurgery; Neurosurgical Procedures; Treatment Outcome
PubMed: 35255626
DOI: 10.1016/j.wneu.2021.12.079 -
The Journal of Hand Surgery, European... Jun 2024This article reviews the history of peripheral nerve (PN) injuries and successive advances in their management by notable pioneers, an interesting topic that I chose for... (Review)
Review
This article reviews the history of peripheral nerve (PN) injuries and successive advances in their management by notable pioneers, an interesting topic that I chose for my Doctoral Thesis in 1990 in Madrid. Mentioning all their names and contributions is an obligatory tribute, and I offer my sincere apologies for inevitably leaving a few out. For half a century I have witnessed microsurgery advances, and also experienced frequent failures in my practice with the use of new techniques; a testimony that we are very far from achieving the 'Holy Grail' of complete PN recovery for these injuries. Our experience is often like a pendulum, from nihilism to optimism and vice versa. Many factors influence the results of PN repair. Fortunately, microsurgery has been a breakthrough but, too often, emergency surgery is carried out by surgeons without enough tools and experience, both very important factors in this field.
Topics: Humans; History, 19th Century; History, 20th Century; History, 21st Century; Microsurgery; Peripheral Nerve Injuries; History, Ancient
PubMed: 37728740
DOI: 10.1177/17531934231198455 -
Spine Apr 2021Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM.
METHODS
Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months).
RESULTS
We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24).
CONCLUSION
There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
Topics: Cost-Benefit Analysis; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery; Pain Measurement; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33290374
DOI: 10.1097/BRS.0000000000003843 -
Clinics in Plastic Surgery Apr 2021Supermicrosurgery is defined as microsurgery working on vessels less than 0.8 mm, allowing applications in smaller-dimension microsurgery, such as lymphedema, minimal... (Review)
Review
Supermicrosurgery is defined as microsurgery working on vessels less than 0.8 mm, allowing applications in smaller-dimension microsurgery, such as lymphedema, minimal invasive reconstruction, small parts replantation, and application of perforator as recipient. To accommodate this technique, developments and use of finer instruments, smaller sutures, new diagnostic tools, and higher-magnification microscopes have been made. Although supermicrosurgery has evolved naturally from microsurgery, it has developed into a unique field based on different thinking and tools to solve problems that once were difficult to solve.
Topics: Contraindications, Procedure; Humans; Lower Extremity; Microsurgery; Perforator Flap; Postoperative Care; Plastic Surgery Procedures; Replantation
PubMed: 33674051
DOI: 10.1016/j.cps.2020.12.009 -
Clinics in Plastic Surgery Oct 2020As microsurgical expertise has improved, allowing for the safe transfer of smaller and more refined flaps, free tissue transfer has continued to gain popularity for the... (Review)
Review
As microsurgical expertise has improved, allowing for the safe transfer of smaller and more refined flaps, free tissue transfer has continued to gain popularity for the management of pediatric soft tissue and bony defects. For the past 2 decades pediatric microsurgery has been shown to be technically feasible and reliable. The major advantage of free tissue transfer in children is the ability to reconstruct defects in a single stage, avoiding the historic treatments of skin grafting, tissue expansion, and pedicled flaps. This article reviews the present state-of-the-art in pediatric microsurgery.
Topics: Child; Child, Preschool; Female; Free Tissue Flaps; Humans; Male; Microsurgery; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Tissue Expansion
PubMed: 32892801
DOI: 10.1016/j.cps.2020.06.008 -
Clinics in Plastic Surgery Jul 2024Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site... (Review)
Review
Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site morbidity. Despite being rarely used, flap reconstruction becomes necessary when critical structures are exposed, offering robust coverage and reducing complications. However, free flaps in acute burns face challenges, including a higher failure rate attributed to hyperinflammatory states and hypercoagulability. Surgical optimization strategies involve careful timing, patient preparation, and meticulous postoperative care. In delayed burn reconstruction, free flaps proved effective in functional and aesthetic restoration, with low flap loss rates and minimal contracture recurrence. Prefabricated and prelaminated flaps emerged as a solution for complex cases, ensuring the best functional and aesthetic possible outcomes in challenging facial burn reconstructions.
Topics: Humans; Burns; Microsurgery; Plastic Surgery Procedures; Free Tissue Flaps; Skin Transplantation
PubMed: 38789149
DOI: 10.1016/j.cps.2024.02.005