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Gastrointestinal Endoscopy Clinics of... Oct 2019Cold resection for small colonic polyps, and larger lesions, is being rapidly and widely adopted. Driven by an impressive safety and cost profile compared with... (Review)
Review
Cold resection for small colonic polyps, and larger lesions, is being rapidly and widely adopted. Driven by an impressive safety and cost profile compared with conventional polypectomy, these advantages are offset by the limitations of smaller and shallower resection, and absent thermal effects that may permit persistence of residual neoplasia. To overcome this, optimal cold snare technique requires inclusion of a margin of normal mucosa and a piecemeal resection technique for larger polyps. This article examines the fundamentals of cold snare resection and evidence for its application, theorizes on limits to its application, and identifies areas for further research.
Topics: Cautery; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Cryosurgery; Endoscopic Mucosal Resection; Forecasting; Humans; Microsurgery
PubMed: 31445693
DOI: 10.1016/j.giec.2019.06.003 -
Asian Journal of Andrology 2023Robot-assisted surgery is the gold standard of treatment in many fields of urology. In this systematic review, we aim to report its usage in andrology and to evaluate...
Robot-assisted surgery is the gold standard of treatment in many fields of urology. In this systematic review, we aim to report its usage in andrology and to evaluate any advantages. A systematic search of the PubMed and Cochrane Library databases was conducted to identify articles referring to robotic-assisted microsurgery in andrology. The search strategy was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook. The articles were then reviewed by two authors. A qualitative analysis of the articles that met the inclusion criteria was performed. Thirty-one articles that met the inclusion criteria were reviewed. The first results for robot-assisted vasovasostomy (RAVV) are encouraging as excellent patency rates, short operative times, and learning curves were achieved. Interestingly, patency rates were greater in some case series for RAVV than for microsurgical vasovasostomy, with a statistically significant difference. In addition, robot has been shown to be of great use in bypassing fibrotic changes in cases of iatrogenic vasal injuries, difficulties encountered with traditional microsurgery. In addition, the feasibility of robot-assisted microsurgery has been proven for varicocelectomy and microsurgical denervation of the spermatic cord, with acceptable improvement in sperm parameters and pain, respectively. The current evidence suggests that there are potential advantages of the use of robots in andrology. However, for robotic surgery to become incorporated into the daily use of the andrologists, large, multicenter randomized trials are needed. As robotics systems are becoming standard in urology practice, it is reasonable for one to believe that they will also find their place in andrology.
Topics: Male; Humans; Robotics; Microsurgery; Andrology; Semen; Vasovasostomy; Multicenter Studies as Topic
PubMed: 36656176
DOI: 10.4103/aja202295 -
Clinics in Plastic Surgery Oct 2020Microsurgery has broad applications in reconstructive surgery. As techniques, diagnostics, and advancing technology rapidly evolve, reconstructive microsurgeons can... (Review)
Review
Microsurgery has broad applications in reconstructive surgery. As techniques, diagnostics, and advancing technology rapidly evolve, reconstructive microsurgeons can adapt to address new challenges and push the frontiers to achieve optimal functional and aesthetic reconstruction, and minimize donor site morbidity. This article briefly outlines some of the recent advances and innovations in microsurgery within the last 5 years in perforator flaps, breast, lymphedema surgery, extremity reconstruction, targeted muscle reinnervation, head and neck reconstruction, composite tissue allotransplantation, and robotic surgery.
Topics: Breast; Esthetics; Extremities; Female; Humans; Male; Microsurgery; Perforator Flap; Plastic Surgery Procedures; Surgery, Computer-Assisted
PubMed: 32892808
DOI: 10.1016/j.cps.2020.07.002 -
Clinics in Plastic Surgery Oct 2020Head and neck reconstructive microsurgery is constantly innovating because of a combination of multidisciplinary advances. This article examines recent innovations that... (Review)
Review
Head and neck reconstructive microsurgery is constantly innovating because of a combination of multidisciplinary advances. This article examines recent innovations that have affected the field as well as presenting research leading to future advancement. Innovations include the use of virtual surgical planning and three-dimensional printing in craniofacial reconstruction, advances in intraoperative navigation and imaging, as well as postoperative monitoring, development of minimally invasive reconstructive microsurgery techniques, integration of regenerative medicine and stem cell biology with reconstruction, and the dramatic advancement of face transplant.
Topics: Face; Facial Transplantation; Head; Humans; Microsurgery; Neck; Printing, Three-Dimensional; Plastic Surgery Procedures; Skull; Surgery, Computer-Assisted
PubMed: 32892802
DOI: 10.1016/j.cps.2020.06.009 -
American Journal of Otolaryngology 2023Tonsillectomy is one of the most frequent surgical procedures performed by ENT surgeons. The high-definition 3D exoscope showed to be a promising tool to substitute the...
Tonsillectomy is one of the most frequent surgical procedures performed by ENT surgeons. The high-definition 3D exoscope showed to be a promising tool to substitute the operating microscope in performing microsurgical procedures. However, transoral surgery might represent an innovative application of this visualization and magnification tool. In this video, a bilateral tonsillectomy was performed entirely under exoscopic visualization by an ENT resident. The high-definition 3D exoscope allowed to conduct the procedure with higher precision, with potential benefits in terms of complications and postoperative pain. Moreover, the use of the exoscope demonstrated important benefit from the educational perspective, allowing the senior surgeon to continuously monitor the resident without interruptions and position changes. The exoscopic-assisted tonsillectomy is a valuable alternative to conventional transoral procedures, and the superiority of this technique should be further investigated in cohort studies.
Topics: Humans; Neurosurgical Procedures; Tonsillectomy; Microsurgery; Microscopy
PubMed: 36302327
DOI: 10.1016/j.amjoto.2022.103674 -
Journal of Reconstructive Microsurgery Oct 2023Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed...
BACKGROUND
Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model.
METHODS
A training curriculum was delivered over 5 days between 2017 and 2020 focusing on (1) microscopic field manipulation, (2) knot tying, nondominant hand usage, (3) 3-D models/anastomosis, and (4) tissue experience. The Kirkpatrick model was applied to evaluate the curriculum at four levels: (1) participants' feedback (2) skills development using a validated, objective assessment tool (Global Assessment Score form) and CUSUM charts were constructed to model proficiency gain (3) and (4) assessing skill retention/long-term impact.
RESULTS
In total, 155 participants undertook the curriculum, totaling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for "good." All participants agreed that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1 and 3 (median score 4) and days 4 and 5 (median score 5) (W = 494.5, = 0.00170). The frequency of errors reduced with successive attempts (chi square = 9.81, = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring 11 attempts on average to reach proficiency. In total, 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation, and actions to address them were implemented in the following programs.
CONCLUSION
Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows the identification of areas of improvement, driving the refinement of training programs.
Topics: Humans; Microsurgery; Clinical Competence; Curriculum; Internship and Residency; Learning Curve
PubMed: 36564051
DOI: 10.1055/a-2003-7689 -
World Neurosurgery Aug 2023Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical...
BACKGROUND
Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical dexterity, which depend on visual identification of cisternal microvasculature. We describe a novel standardized operative sequence to allow for bloodless arachnoid dissection when cisternal anatomy is challenging.
METHODS
We used the reported technique in 1928 cases over the past 5 years (2018-2022). The outer arachnoid was incised to enter the cisternal space. A cotton pledget was placed in contact with an inner membrane and gently pushed laterally and superficially with the suction cannula at medium suction power. When the arachnoid membranes dried, arachnoid trabeculae were cut and microvasculature were released at the convexity of their loops and gently transposed off the dissection trajectory. The same principle was used to release parent and perforating arteries from the aneurysm dome.
RESULTS
The microcisternal drainage technique enabled safe and efficient access through adhered arachnoid in all cases. A complex anterior communicating artery aneurysm in a 52-year-old lady demonstrated the use of the microcisternal drainage technique during access through the pericallosal cistern. This technique was used in all cases where cisternal dissection was needed.
CONCLUSIONS
The microcisternal drainage technique uses deliberate and strategic suction, dynamic retraction, and nuanced scissor cuts to enable precise and bloodless microdissection of adherent arachnoid cisterns. This technique combines common neurosurgical maneuvers in a novel standardized sequence to improve efficiency and safety during arachnoid dissection.
Topics: Female; Humans; Middle Aged; Subarachnoid Space; Arachnoid; Microsurgery; Intracranial Aneurysm; Drainage
PubMed: 37105274
DOI: 10.1016/j.wneu.2023.04.087 -
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 -
Hand Surgery & Rehabilitation Jun 2022Numerous microsurgical training techniques and materials have been developed to reduce animal use and training costs. This systematic review aimed to catalog the...
Numerous microsurgical training techniques and materials have been developed to reduce animal use and training costs. This systematic review aimed to catalog the available microsurgery learning methods on non-living material in order to define an educational program. The PubMed database was searched for English and French articles related to the initial learning of microsurgery with inert, non-living, or digital material and containing the keywords "microsurgery", "non-living", "simulation" and "virtual reality". Among the 488 articles found, 82 were included. This work reports the main microsurgery learning supports. They were classified according to the material used: inert material, cadaveric animal tissues, human cadaver model, virtual reality, and digital technologies. The educational program proposes here is a two-step program that uses non-living material (basic and deepening) before progressing to living models. This initial learning phase teaches basic microsurgical skills (precision, tremor management, and magnification). Then, frequent home training sessions help to maintain the acquired skills. Ethical, organizational, and economic constraints limit access to animal models. Therefore, inert models seem to be ideal support for initial microsurgical learning. The multiplicity of models described makes it possible to achieve progressive learning depending on which models are available.
Topics: Animals; Clinical Competence; Computer Simulation; Humans; Learning; Microsurgery
PubMed: 35158091
DOI: 10.1016/j.hansur.2022.02.001 -
Missouri Medicine 2021
Topics: Humans; Microsurgery; Plastic Surgery Procedures; Surgery, Computer-Assisted
PubMed: 33840859
DOI: No ID Found