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At least 271 records · Page 15Linked to original sources

PubMed1994

[Therapy of hypopharyngeal cancer. Part IV: Long-term results of transoral laser microsurgery of hypopharyngeal cancer].

Between 1979 and 1986, 74 patients with hypopharyngeal carcinomas were operated using transoral laser microsurgery by the first author. 32 of the patients were subdivided into 5 subgroups and considered separately because of pretreatment for head and neck tumors, simultaneous multiple tumors etc. (excluding criterias). Survival times were not significantly prolonged and lasted 1-27 months (median, 11 months), but the quality of life was improved due to preservation or restoration of natural laryngopharyngeal functions. Forty-two patients were operated with curative intention. This group primarily underwent transoral laser microsurgery, aiming at complete locoregional tumor resection with function preservation (pT1, 5; pT2, 31; pT3, 4; pT4, 2). In 29 patients 31 necks were operated, mostly as a regionally limited functional neck dissection (or "selective" neck dissection). In 90% of the cases neck metastases (pN+) were found, mostly in levels II and III; pN1, 6; pN2a, 1; pN2b, 18; pN2c, 1. Altogether, stages III and IV were found in 71.4% of the patients. A temporary tracheotomy was required in four patients. There was no secondary laryngectomy, even though it was indicated in one case. Post-treatment oncological followup (median observation time, 104 months) demonstrated loco-regional recurrences (n = 1), late or recurrent metastases (n = 4), persisting metastases in the neck with cerebral metastasis (n = 1), distant metastases (n = 4), secondary tumors (n = 9, 5 of which occurred in the head and neck). Through March 1993, 24 patients (57%) have died. Causes were TNM-related (7), second primary tumor with or without distant metastases (8) and intercurrent disease with no evidence of disease (9). Within 5 years 17% of the patients died of TNM-related tumors, 9.5% due to a second primary with or without distant metastases, as well as 9.5% with intercurrent disease. The 5-year overall survival rate was 64% and was 83% (adjusted survival rate) if only TNM-related deaths were considered.

Adult↗

PubMed1976

Practical microsurgery.

The reconstructive surgeon who wishes to learn microsurgery must realize that its acquisition demands extensive practice in the research laboratory with clinical application occurring after perfection of the fundamental techniques. Their initial usage should be in traumatic extremity injuries followed by replantation of complete and incomplete amputations. Elective reconstructive microsurgery demands consummate clinical skills and should not be attempted except by those who have convincingly demonstrated their microsurgical skills either in replantation surgery or in the research laboratory.

Animals↗

PubMed1994

Transanal endoscopic microsurgery in Italy.

The Italian experience with Transanal Endoscopic Microsurgery (TEM) started in 1991. Until April, 1994, 122 patients were operated on by such a technique in six centres. The surgical protocol in the 66 patients with benign lesions was similar to that described by Buess. In contrast to the German experience, the indications of TEM for cancer have been extended to more advanced tumours and in 22 out of 56 patients with rectal carcinoma adjuvant radiation- or radiation-chemotherapy have been applied according to various protocols. In 88% of TEM for rectal tumours the operation has been carried out according to a full-thickness technique, with or without perirectal fat excision. Postoperative morbidity of TEM for adenoma was 15.8% and that of TEM for carcinoma 29.6%. There was no postoperative mortality. Local recurrence rate after TEM for adenoma was 10.5%, while that after TEM for cancer was 9.25%. No local recurrence has been reported among patients treated with a combination of TEM and adjuvant radiation treatments. The median follow-up in the 6 centres ranged between 7 and 16 months. A randomised prospective clinical trial has been planned in order to evaluate the role of transanal endoscopic microsurgery in the treatment of locally advanced rectal cancer.

Adenocarcinoma↗

PubMed1994

An overview of periodontal microsurgery.

Optical magnification has broadened the horizons of dentistry in general and periodontics in particular. Improvement in visual acuity, made possible through optical magnification, is becoming an integral part of modern dental practices. Through the quiet trend toward microdentistry, the authors have used microsurgical principles to improve visual acuity and the precision of existing surgical techniques to broaden the scope and character of periodontics, with knowledge and technology borrowed from medicine. The effect of periodontal microsurgery may include more predictable therapeutic results, less invasive procedures with reduced patient discomfort, more rapid healing, improved cosmetic results, and greater patient acceptance. This article provides a brief overview of magnification in dentistry and how it is used in periodontal microsurgery as applied to reconstructive gingival surgery in the treatment of gingival recession.

Gingival Recession↗

PubMed1993

Transanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument.

In order to save time for changing instruments and minimize thermal damage in underlying tissue caused by monopolar high frequency in transanal endoscopic microsurgery (TEM), we have developed a new electrosurgical instrument, in which four functions are integrated: bipolar cutting, monopolar coagulation, suction and irrigation. The new device and the conventional monopolar knife were tested during both in vitro and in vivo experiments to compare the thermal alterations and effects on operating time. In vitro experiments demonstrated that the extent of thermal alterations created by bipolar cutting was less than in the case of monopolar cutting in the fresh porcine liver and bovine rectum. The mean severity scores for carbonization, coagulation and vacuolization in the resected mucosae obtained during in vivo animal operations by the bipolar procedure were 2.09, 2.27 and 1.36, respectively, whereas those obtained using the monopolar technique were 2.64, 2.82 and 2.36, respectively. The new device required an average operation time of 673.5 seconds, whereas the conventional setup required 701.9 seconds to resect the same diameter of rectal mucosa. Reduced operation time with the new device was mainly attributable to the reduced time needed for changing the instruments for hemostasis. The decreased thermal damage to the underlying bowel wall produced by the bipolar procedure should reduce the incidence of such operative complications in TEM (Transanal Endoscopic Microsurgery, developed in 1983 by Buess, Theis and Hutterer) as perforation, dehiscence in the suture line or post-polypectomy coagulation syndrome. By quickly switching between the multiple functions of this new device a clear operative field can always be achieved, thus decreasing operation time and bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Anal Canal↗

PubMed1994

[Microsurgery and reconstruction in facial oncology].

The desire to improve the post-operative lives of throat cancer patients and the additional problem posed by trying to conceal visible facial scars are the main motivations of reconstructive surgery in facial cancer treatment. In this field, microsurgical techniques have found their place and are used to the upmost efficiency when the final result is taken into account. Even better, these techniques are used to attempt an accurate reconstruction of different structures destroyed by the tumor or drastic surgical intervention, by using other parts of the patient's body. Microsurgery is bringing us closer to the miracles of Cosmas and Damian, the legend that surrounds. Tagliacozzi, the figures of surrealistic pantings, and the universival myth of the mask... The relative youth of these techniques in the facial cancer field and the lack of effective medical treatments lead us to believe that its potential growth is quite large and promising. Four distinct chapters are used to illustrate the different microsurgical techniques in cutaneous tissue loss, mucous tissue loss, bony tissue loss and the repair of sequellas. But reality reminds us that tissue composition is much more complex and that even today, microsurgery offers only a crude replacement in relation to the structures that it seeks to reconstruct.

Bone Transplantation↗

PubMedDate not supplied

Microsurgery in the treatment of crural and sciatic pain due to disc and bone compression: considerations on the first 100 cases.

The authors present the results they obtained in the first 100 operations performed between January 1989 and November 1990 for the treatment of lumbar sciatic pain related to disc and/or bone compression: microsurgery according to the Caspar method was used. A total of 113 spaces were submitted to surgery; discectomy at two levels was performed in 13 patients. Nerve root compression observed was based on three causes: 1) pure disc hernia (57.5%), 2) pure lateral stenosis (15.9%), 3) combined pathology (hernia+stenosis) (25.6%). In one of the cases the pathology remained unknown. At an average two-year follow-up there were 94 excellent or good results, 2 fair results, and 4 poor results. Complications included dural lacerations in 3 cases, with no sequelae. Eight patients were submitted to further surgery for recurrence of symptoms; the final results after reintervention were excellent in 7 cases, and fair in 1. The authors emphasize the advantages to using microsurgery as compared to macrosurgery, and stress a frequent finding of pure lateral stenosis or associated with disc pathology (47 out of 113 levels operated, equal to 41%), as well as the reliability of CT scan when dealing with disc pathology (97% positive diagnosis) but its unreliability when diagnosis is lateral stenosis (19 out of 47, equal to 40%).

Adult↗

PubMed1993

[Reconstructive microsurgery in the elderly].

Between 1989 and 1990, 20 patients older than 60 years underwent reconstructive microsurgery in our hospital. The procedures consisted of 6 digital replantations in 5 patients and 17 free tissue transfers in 15 patients. The success were 5 out of 6 digital replantations and 16 out of 17 free tissue transfers. This success rate had no significant difference compared with other age groups of our reconstructive microsurgery series. There was no additional complications which might always be considered to encounter with elder patients after prolonged anesthesia. We conclude that with good preoperative work up, careful intraoperative or postoperative care as well as meticulous operative technique, the operative risk remains low and the success rate is comparable to other age groups.

Age Factors↗

PubMed1996

[Transanal endoscopic microsurgery].

Transanal endoscopic microsurgery was introduced by Buess and co-workers in 1984 for transanal removal of tumours up to 20 cm above anus. In the present study, 18 transmural and two mucosal resections were performed for rectal adenomas (16) and early rectal cancer (4). Median operation time was 85 minutes (55-140 minutes) and the median postoperative stay in hospital was 3 days (1-5). All tumours were removed radically and in none was there tumour involvement of the resection margin. There were no serious complications. After a median observation time of 10 months (1-17 months) there have been no recurrences. Functional results are excellent; none of the patients have developed incontinence. It is concluded that transanal endoscopic microsurgery (TEM) is an adequate method for removal of benign rectal tumours and, in selected cases, early rectal cancer.

Adenoma↗

PubMed1995

Microsurgical aspects of the treatment of azoospermia. The BMFT Study Group for Microsurgery.

Technical advances in microsurgery have produced a calculable success rate for reconstructive surgery in cases of obstructive azoospermia. Nevertheless, in standardized vasovasostomy and tubulovasostomy, the different outcomes for patency and pregnancy indicate that further comprehensive clinical and basic scientific studies are required to improve the results of surgery. The aspiration of epididymal and testicular spermatozoa in combination with intra-cytoplasmic sperm injection (ICSI) is one example of a fruitful integration of microsurgery into new areas of reproductive medicine. Where there is ejaculatory duct obstruction, the continuity with the posterior urethra can be restored by a transurethral operation.

Humans↗

PubMed1996

[Falloposcopy for preoperative evaluation before microsurgery].

In order to optimize the preoperative evaluation prior to microsurgery falloposcopy was performed in 105 patients using the Imagyn-System. In 28% of the patients the indication for operative intervention was confirmed. The pregnancy rate in the group of patients with normal falloposcopy pattern was 69% whereas a rate of only 17% was registered in patients with intratubal pathology. The rate of ectopic pregnancies was 2%. We conclude that the preoperative use of falloposcopy will be beneficial during evaluation of microsurgery candidates.

Adult↗

PubMedDate not supplied

Microsurgery and changes in the testicular and epididymal production of spermatozoa.

The researchers studied a group of azoospermic patients with obstructions of the seminal canals and a group of oligoasthenospermic patients suffering from varicocele in order to analyze the factors that influence the success of surgery aimed at recovering fertility. In the 46 patients suffering from obstructions of the deferent duct and the extremity of the epididymis, the time factor proved decisive if the obstruction lasted longer than 6 years: in this case, damage to the seminiferous tubules is not reversible. With obstructions dating back less than 4 years, the causes and the location of the obstruction are more incisive. Success was achieved in 100% of vasectomy cases and in 37.5% of epididymal-deferential anastomoses. In research literature, the superiority of microsurgery for treating these types of pathologies is taken for granted. In patients affected by oligoasthenospermia the effectiveness of laparoscopic ligation of the spermatic veins was compared to that of the Belgrano I technique. Of the 30 patients with bilateral varicocele and oligoasthenospermia dating back less than 4 years, 73.3% of the 15 patients operated on using the Belgrano 1 technique experienced sperm normalization; in the 15 cases operated on using laparoscopic ligation of the spermatic canals, normalization was much less frequent. Seventy-five percent of another group of 40 patients whose infertility did not have a duration of longer than 4 years and were operated on using microsurgery techniques were normalized. The percentage of the 60 oligoasthenospermic patients for longer than 6 years normalized was 16.6%.

Epididymis↗

PubMed1996

Co-administration of midazolam decreases propofol dose during anesthesia in endoscopic laryngeal microsurgery.

BACKGROUND: Propofol is commonly used in total intravenous anesthesia (TIVA) for brief surgical procedures because it offers rapid recovery and has fewer side effects. However, concomittent use of other adjuvant agents has been considered so that the same anesthetic effects can be achieved at lower doses of propofol which is more expensive without compromising rapid recovery and increasing the adverse effects. This study was therefore designed to evaluate the co-administration of midazolam and propofol during anesthesia for endoscopic microsurgery and test its influences on the consumption of propofol and the quality of anesthesia. METHODS: Forty-two patients receiving selective endoscopic microsurgery were enrolled in this study. All patients received high frequency jet ventilation (HFJV) under TIVA. The control group (n = 21) received propofol (20 mg/5 s) during induction and 10 mg/kg/h as maintenance. The study group (n = 21) received midazolam (0.06 mg/kg) and propofol (20 mg/5 s) for induction with propofol 8 mg/kg/hr for maintenance. Doses of propofol, vital signs, recovery time, post-anesthetic high cortical function, and adverse events were evaluated and compared. RESULTS: Co-administration of midazolam and propofol in TIVA could reduce the induction dose and the total dose of propofol by 51% and 26% respectively but still achieve the same anesthetic effects. Vital signs and recovery were not influenced, and incidence of adverse effects did not increase. CONCLUSIONS: Our result suggests that co-administration of midazolam and propofol in TIVA appears to be safe, effective, and economic alternative to that with propofol alone. The effects were synergic but side effects were not.

Adult↗

PubMedDate not supplied

Laparoscopic tubal surgery. A retrospective comparative study of open microsurgery versus laparoscopic surgery.

The aim of this study is to compare retrospectively the outcome of patients that underwent tubal surgery by laparotomy or laparoscopy by the same surgeon Thirty two women that presented with distal tubal obstruction were treated by laparoscopic tubal surgery and 38 by laparotomy and microsurgery. Patients were equally matched for age, duration of infertility and severity of disease. In all cases there were no injuries to adjacent groups and no additional surgery was needed. The duration of surgery was 35-60 min for laparoscopy and 70-120 min for laparotomy and mean duration of hospital stay was 2 and 7 days respectively. Of the 32 cases that underwent laparoscopic surgery 10 had intrauterine pregnancies (31.25%) and 2 ectopic (6.2%). Conversely 11 (28.9%) of the 38 cases with tubal microsurgery resulted in intrauterine pregnancy and 4 (10.5%) in ectopic. Our results suggest that laparoscopic tubal surgery is the method of choice for the treatment of distal tubal obstruction.

Adult↗

PubMed1996

[The organization of microsurgery at a provincial center].

The 5-year experience of microsurgery in regional medical centre is analysed. 1014 operations were performed. Certain managerial items and practical recommendations, necessary for development of microsurgery in regional medical centers are discussed. The importance of a close contract with other surgical services is advocated.

Elective Surgical Procedures↗

PubMed1997

Principles of endodontic microsurgery.

With bright illumination and magnification under the operating microscope, and addition of many microinstruments, endodontic surgery has become microsurgery. The microsurgical approaches allow the clinicians to perform endodontic surgery with smaller osteotomies, shallow bevels, preparation of isthmuses, examination of resected root surfaces, retropreparation in line with root canal, and precise placement of new filling materials. This article illustrates the advantages of microsurgery in endodontics.

Alveolectomy↗

PubMed1997

Hemostasis in endodontic microsurgery.

There are numerous ways to achieve hemostasis. With the abundance of hemostatic agents available and with the introduction of new products, one has to make an objective decision. A good agent achieves hemostasis within a short period of time, is easy to manipulate, is biocompatible, does not impair or retard healing, must be relatively inexpensive, is reliable, and works best for the particular surgical procedure. With these purposes in mind, the following sequence is recommended to achieve hemostasis during endodontic microsurgery. I. Presurgical: Give 2 to 3 Carpules of 1:50,000 epinephrine local anesthetic with multiple infiltration sites throughout the entire surgical field. II. Surgical: A. Remove all granulation tissue. B. Place an epinephrine pellet into the bony crypt followed by dry sterile cotton pellets. Apply pressure for 2 minutes. Remove all the cotton pellets except the first epinephrine pellet. Continue with the surgical procedure and remove the epinephrine pellet before final irrigation and closure. C. Alternatively, calcium sulfate can be mixed into a thick putty and packed against the bone cavity. Because it is a biodegradable material, calcium sulfate can be left in situ. In fact, in large bone defects and through-and-through lesions, additional calcium sulfate can be placed to fill the entire bone cavity as a barrier material. Healing is more predictable with little chance of scar tissue formation. Calcium sulfate resorbs in 2 to 4 weeks. D. Small bleeding sites in the bone can be brushed with ferric sulfate solution. III. Postsurgical: Tissue compression before and after suturing cuts down on postsurgical bleeding and swelling. Hemostasis is imperative in endodontic microsurgery for better visualization, a good environment for placement of retrograde filling material, and a more efficient surgical procedure with less blood loss.

Alveolectomy↗

PubMed1997

[Microsurgery of cataracts in glaucoma].

In a group of 205 implantations of artificial intraocular lenses in 172 patients with glaucoma the authors demonstrate that microsurgery of cataract with implantation, in particular of posterior chamber lenses, has also a permanent hypotonic effect. 155 eyes (75.6%) with primary glaucoma were operated and 50 eyes (24.4%) with secondary glaucoma, 198 times (96.6%) primary implantation was used and 7 times (3.4%) secondary implantation. The highest ratio in the group was formed by extracapsular extractions in 95.0%, intracapsular extractions in 3% and phacoemulsification in 2%. One of the greatest obstacles of microsurgery of cataract in eyes affected with glaucoma is the narrow pupil. The authors give an account of possible solutions of this problem. Vision of 5/10 or better with correction was achieved in 68.8%. The most frequent cause of reduced vision of less than 5/50 was atrophy of the TZN in 11.25% Permanent compensation of intraocular pressure without further treatment was observed in 64.4% during a mean follow-up period of 66.7 months.

Adult↗