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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 -
Fertility and Sterility Oct 2018
Comparative Study
Topics: Cost-Benefit Analysis; Humans; Male; Microsurgery; Robotic Surgical Procedures; Sterilization Reversal; Treatment Outcome; Varicocele; Vasectomy; Vasovasostomy
PubMed: 30316417
DOI: 10.1016/j.fertnstert.2018.08.026 -
The British Journal of Ophthalmology Jan 2007Bimanual, three-dimensional robotic surgery has proved valuable for a variety of surgical procedures.
BACKGROUND
Bimanual, three-dimensional robotic surgery has proved valuable for a variety of surgical procedures.
AIMS
To examine the use of a commercially available surgical robot for ocular microsurgery.
METHODS
Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360 degrees -rotating, 8-mm, wrested-end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10-0 sutures, and this was documented with still and video photography.
RESULTS
Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level.
CONCLUSIONS
Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state-of-the-art surgical skill and technology.
Topics: Animals; Cornea; Corneal Injuries; Disease Models, Animal; Equipment Design; Feasibility Studies; Imaging, Three-Dimensional; Laparoscopy; Manikins; Microsurgery; Minimally Invasive Surgical Procedures; Ophthalmologic Surgical Procedures; Postoperative Care; Robotics; Suture Techniques; Swine; Time Factors
PubMed: 17020903
DOI: 10.1136/bjo.2006.096040 -
Arquivos de Neuro-psiquiatria Jun 2010The pterional craniotomy is one of the most frequently surgical approaches used in neurosurgery and currently it has become a mainsteam. It allows excellent... (Review)
Review
The pterional craniotomy is one of the most frequently surgical approaches used in neurosurgery and currently it has become a mainsteam. It allows excellent microsurgical exposure of anterior and posterior regions of the arterial circle of Willis, supra and paraselar regions, the superior orbital fissure of sphenoid bone, cavernous sinus, orbit, temporal lobe, midbrain and the frontal lobe. Like others techniques, the pterional craniotomy presented disadvantages related to dissection of the temporal muscle. From the first fronto lateral craniotomy described by Dandy to expose the optic chiasm and the pituitary we pass through the Yasargil's classical description of craniotomy centered in fronto-temporal sylvian fissure until reaching the recent"minipterional craniotomy", modifications of the pterional craniotomy were proposed to reduce the extra cranial tissue trauma and reduce the area of craniotomy without affecting the exposure of surgical targets, thus improving their aesthetic and functional results. An historical analysis of the frontolateral approaches has demonstrated that they have evolved from larger craniotomies to smaller ones, however only the minipterional craniotomy is able to offer similar surgical exposure.
Topics: Craniotomy; Humans; Microsurgery
PubMed: 20602050
DOI: 10.1590/s0004-282x2010000300020 -
Acta Otorhinolaryngologica Italica :... Apr 2024In carotid paraganglioma surgery, magnification is crucial to properly evaluate the anatomical relationships between mass, carotid wall, cranial nerves, tumour vascular...
OBJECTIVES
In carotid paraganglioma surgery, magnification is crucial to properly evaluate the anatomical relationships between mass, carotid wall, cranial nerves, tumour vascular supply and fascial envelope. The aims of this study are to describe the microsurgical technique, along with the underlying microsurgical anatomy, and to assess outcomes in terms of disease control, complications and functional results.
METHODS
Twenty-six patients, accounting for 29 carotid paragangliomas, treated with microsurgery by the same senior surgeon over a 35-year period, were included.
RESULTS
No carotid injury requiring repair, nor peri- or post-operative stroke occurred in this series. No surgical injury of the main trunk of VII to XII cranial nerves occurred. Complete excision was obtained in all cases and no recurrence was observed during follow-up.
CONCLUSIONS
The small study size and its retrospective nature suggests caution; however, our results show that microsurgery can allow a safe and precise dissection of the carotids and nerves.
Topics: Humans; Carotid Body Tumor; Microsurgery; Middle Aged; Male; Female; Retrospective Studies; Adult; Aged
PubMed: 38651551
DOI: 10.14639/0392-100X-N2761 -
International Dental Journal Oct 2022This study aimed to compare the healing outcomes of endodontic microsurgery (EMS) using 2-dimensional (2D) and 3-dimensional (3D) radiographic evaluation in a Chinese...
OBJECTIVE
This study aimed to compare the healing outcomes of endodontic microsurgery (EMS) using 2-dimensional (2D) and 3-dimensional (3D) radiographic evaluation in a Chinese population. The prognostic factors of EMS were identified according to the 2D and 3D healing classifications.
MATERIALS AND METHODS
The teeth (n = 82) were studied using 2D and 3D radiographic examinations. The 2D and 3D healing criteria were used to evaluate the healing outcome. Prognostic factors were investigated based on healing outcomes. Data were analysed using SPSS, and P < .05 was considered significant.
RESULTS
There were significant differences between 2D and 3D healing outcomes (P = .004). For the 3D images, age older than 45 years was found to be a significant negative predictor (P = .005).
CONCLUSIONS
Cone-beam computed tomographic images provided more precise evaluation of periapical lesions and healing outcomes of EMS than conventional periapical radiographs. Age (>45 years) of the patients exhibited a significant influence on the healing outcome of EMS as determined using 3D images.
Topics: Cone-Beam Computed Tomography; Humans; Microsurgery; Middle Aged; Prognosis; Wound Healing
PubMed: 35331471
DOI: 10.1016/j.identj.2022.02.007 -
Techniques in Coloproctology Feb 2013The aim of oncologic surgery is radical cancer treatment with preservation of function and quality of life. Almost 30 years ago, transanal endoscopic microsurgery (TEM)... (Review)
Review
The aim of oncologic surgery is radical cancer treatment with preservation of function and quality of life. Almost 30 years ago, transanal endoscopic microsurgery (TEM) revolutionised the technique and outcomes of transanal surgery, first becoming the standard of treatment for large rectal adenomas, then offering a possibly curative treatment for early rectal cancer, and finally generating discussion on its potential role in combination with neoadjuvant therapies for the treatment of more invasive cancer. TEM afforded the advantage of combining a less invasive transanal approach with low recurrence rates thanks to enhanced visualization of the surgical field, which allows more precise dissection. We describe the current indications, the preoperative work-up, the surgical technique (with the aid of a video), postoperative management and results obtained in an over 20-year-long experience. Designed as an accurate means to allow excision of benign rectal neoplasms with a very low morbidity rate, TEM today is indicated as a curative treatment of malignant neoplasms that are histologically confirmed as pT1 sm1 carcinomas. T1 sm2-3 and T2 lesions should at present be included in prospective trials. Accurate preoperative staging is essential for optimal selection of patients. Patients with clear indication for TEM should be referred to specialized medical centres experienced with the technique.
Topics: Adenocarcinoma; Anal Canal; Humans; Microsurgery; Minimally Invasive Surgical Procedures; Neoplasm Staging; Proctoscopy; Recovery of Function; Rectal Neoplasms
PubMed: 23314951
DOI: 10.1007/s10151-012-0936-0 -
Acta Otorhinolaryngologica Italica :... Oct 2012Progress in the study of skull base anatomy and the different lesions involving it has led to more and more precise knowledge of the site. New diagnostic tools have... (Review)
Review
Progress in the study of skull base anatomy and the different lesions involving it has led to more and more precise knowledge of the site. New diagnostic tools have allowed better definition of various diseases, and the use of an operative microscope and modern surgical instruments have all contributed to the development of microsurgery of the skull base. Refinements in microsurgical techniques have led to the description of multiple approaches to the skull base. Lateral approaches to the skull base have been described by pioneering surgeons who created the basis of this surgery and further contributed with their own experience. Refinements and modifications to the original technique have taken place over years, to the point that nowadays the large number of approaches described by oto- and neurosurgeons have led to some confusion. We have attempted to simplify this by retracing it to the original, basic steps based on the most representative publications and personal experience.
Topics: Humans; Microsurgery; Skull Base
PubMed: 23326006
DOI: No ID Found -
Turkish Neurosurgery 2018Although endoscopic techniques have many advantages including improved visualization and magnification, they are also associated with limitations. The objective of this... (Review)
Review
Although endoscopic techniques have many advantages including improved visualization and magnification, they are also associated with limitations. The objective of this review is to discuss the practical aspects that can reduce complications after endoscopic procedures, and their management. The review is based on the personal experience of more than 2000 neuroendoscopic procedures performed by the senior author. Topic search was made on PubMed using Neuroendoscopy, complications and neuroendoscopy, complication avoidance and neuroendoscopy, endoscopic neurosurgery, and minimally invasive neurosurgery. Relevant articles were selected after analyzing abstracts and/or topics. Endoscopic procedures are also associated with limitations such as obstruction in instruments manipulation, steep learning curve, blind area, difficulty in visualization, disorientation, loss of stereoscopic image and others. Neuroendoscopy is distinct from microsurgery and the surgeon has to learn endoscopic skills in addition to microsurgical techniques. Difficulties in controlling bleeding, working in a limited area, higher complication rate during the initial learning curve and longer operative time are some of the limitations. Attending live workshops, practicing on models, and hands on cadaveric workshops can reduce the learning curve. Proper case selection, multidisciplinary team approach, watching operative video, visiting other departments, observing a skillful endoscopic surgeon, lab training, and simulators can improve results and shorten the learning curve. Limitations of this review are that the search is limited to the English literature and personal experience of a single surgeon that may create some bias. Although neuroendoscopic techniques are associated with improved results in some indications, they have many limitations. Neuroendoscopic skills need to be learned to improve results.
Topics: Humans; Microsurgery; Neuroendoscopy
PubMed: 27943227
DOI: 10.5137/1019-5149.JTN.18923-16.1 -
Ear, Nose, & Throat Journal Feb 2021Lasers have been used in otolaryngology for more than 40 years and are widely considered an established way of addressing laryngeal pathology, benign and malignant.... (Review)
Review
Lasers have been used in otolaryngology for more than 40 years and are widely considered an established way of addressing laryngeal pathology, benign and malignant. Carbon dioxide (CO) laser is considered a gold standard, but over the last 2 decades, a new technology has been developed and established in other medical specialties, not so much in Ear Nose and Throat (ENT), the diode laser. It consists of a flexible fiber that passes through a hollow guidance system and is capable of reaching certain angled spots easier than straight beam systems. Portability, lower cost, easier setup, and improved photocoagulation are just some of the many features rendering it an excellent choice for the surgeon and the patient. The few studies published worldwide for the usage and efficacy of this system show no major differences related to the oncologic outcome and survival rate of patients having an early glottic tumor between diode laser microsurgery and CO laser cordectomy. Nevertheless, the advantages offered by fiber-optic laser surgery render it a worthy and perhaps equal alternative for treating this kind of pathology.
Topics: Adult; Aged; Aged, 80 and over; Carbon Dioxide; Female; Glottis; Humans; Laryngeal Neoplasms; Laryngectomy; Laryngoscopy; Lasers, Gas; Lasers, Semiconductor; Male; Microsurgery; Middle Aged; Treatment Outcome
PubMed: 32529850
DOI: 10.1177/0145561320932043