PubMed · 5568637
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
B L Kaye. 1971. Useful scissors for fine dissecting.. https://doi.org/10.1016/s0007-1226(71)80079-6
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Postoperative atrophy of the deep back muscles may be caused by denervation during a dorsomedian approach to the thoracolumbar spine; ensuing instability of the spine with poor clinical results, perhaps due to such muscle loss, has been observed in 11.7% of cases (Sihvonen et al., 1993, Spine 18:575--581). More specifically, this complication may be caused by damaging the medial branches of the posterior rami of the spinal nerves during lateral retraction of the muscles. To investigate the anatomic topography of the medial branches of the posterior rami of the spinal nerves, 18 carbol-formol-fixed specimens were dissected using an operation microscope; also, 3 fresh cadavers were cut in horizontal and vertical planes with a rotary cryotome to confirm the anatomic topography observed in the fixed specimens. In the thoracolumbar spine the medial branch of the posterior ramus of the spinal nerve is subject to ligamentous fixation by the strong fibers of the mammillo-accessory ligament, which extends between the mammillary process and accessory process infero lateral to the superior articular process. When the dorsomedian approach to the thoracolumbar spine is enlarged laterally to the articular processes by retracting the paraspinous muscles, the medial branches of the posterior rami of the spinal nerves are endangered. This may cause postoperative pain as well as dynamic instability beyond the corresponding segments. The results of our anatomic study suggest that the posterior surgical midline approach to the thoracolumbar spine should not be enlarged laterally to the articular processes to prevent injury to the medial branches of the posterior rami of the spinal nerves.
BACKGROUND AND OBJECTIVES: Making surgical incisions in vessel-rich organs without causing bleeding is difficult. Thus, it is necessary to develop new devices for this purpose, especially for surgery involving small vessels as in neurosurgery, where damage against even small cerebral vessels result in severe neurological deficits. STUDY DESIGN/MATERIALS AND METHODS: A laser-induced liquid jet was generated by irradiating pulsed Holmium Yttrium-Aluminum-Garnet (Ho: YAG) laser (beams of 350 microseconds pulse width) within a copper tube (internal diameter, 1 mm) with pure water (150 ml /hour). Ho: YAG laser beams were irradiated through an optical fiber (core diameter, 0.4 mm). The influence of the input of laser energy, structure of the nozzle, and the stand-off distance between the optical fiber tip and nozzle exit on the jet velocity was measured by a high-speed video camera to evaluate controllability of jet. The effect on artificial organs made of 10 and 30%(w/v) gelatin, each of which represent features of soft tissue and blood vessels. RESULTS: Jet velocity increased in proportion to gain in laser energy input, and maximum penetration depth into 10%(w/v) gelatin was 35 mm by single exposure at 350 mJ/pulse without impairing a vessel model. Shapes of nozzle also modified jet velocity with optimal nozzle/tube area ratio of 0.25. CONCLUSIONS: The laser-induced liquid jet has excellent potential as a new tool for removing soft tissue without damaging vital structures.
PURPOSE: To evaluate the effect of hydrodissection on intraoperative performance during phacoemulsification of age-related nuclear cataracts. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: In a prospective study, 86 eyes were randomly assigned to have multiquadrant hydrodissection (+HD, n = 48) or no hydrodissection (-HD, n = 38) during phacoemulsification of a grade 1 to 3 nuclear cataract. Excluded were patients with grade 4 or 5 nuclear sclerosis, a poorly dilating pupil, or associated ocular/systemic disease. Parameters assessed were nucleus and cortex removal time, the amount of fluid used for cortex removal, and the total amount of fluid used. The ease of nucleus rotation and cortical cleanup was also evaluated and graded subjectively as very easy, difficult, or very difficult. Data were analyzed using the Student t test and the chi-square test. RESULTS: The mean nucleus removal time was 355 seconds +/- 237 (SD) and 474 +/- 212 seconds in the +HD and -HD groups, respectively (P =.09). The mean cortex removal time was significantly less in the +HD group than in the -HD group (79 +/- 51 seconds and 220 +/- 222 seconds, respectively) (P =.007). Significantly less fluid (43%) was used for cortex removal in the +HD group than in the -HD group (mean 70 +/- 45 mL and 123 +/- 82 mL, respectively) (P =.013), and significantly less total fluid (35%) was used in the +HD group (312 +/- 132 mL and 422 +/- 80 mL, respectively) (P =.002). Nucleus rotation was easy in all eyes in the +HD group; 68.43% of eyes in the -HD group failed to achieve rotation (P =.001). Cortex removal was very easy in 52.08% of eyes in the +HD group and easy in 47.90%; it was easy in 52.63% in the -HD group, difficult in 36.84%, and very difficult in 10.52%. CONCLUSION: The use of multiquadrant cortical-cleaving hydrodissection made removal of the lens nucleus and cortex easier and faster during phacoemulsification of age-related nuclear cataracts.