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At least 307 records · Page 17Linked to original sources

PubMed1991

The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas.

From 1962 to 1987, 126 patients underwent trans-sphenoidal surgery for primary treatment of pituitary adenomas unassociated with clinical or biochemical evidence of hormonal overproduction. There were 73 male and 53 female patients (mean age, 50 +/- 12 years). Before surgery, 56% of the patients (70 of 124) had headaches, 74% (94 of 126) had deterioration of vision, and 12% (15 of 126) had ophthalmoplegia. Endocrine evaluation revealed the presence of hypogonadism in 75% (87 of 115), adrenal insufficiency in 36% (46 of 126), and hypothyroidism in 18% (21 of 122). Plasma prolactin was increased in 65% (56 of 86) with a mean level of 39 +/- 14 micrograms/l (normal, 3 to 20 micrograms/l). Radiologic enlargement of the sella turcica was documented in all cases: 67% (84 of 126) had enclosed and 33% (42 of 126) had invasive adenomas. After surgery, vision was normalized or improved in 75% (71 of 94) of the patients. Thyroid, adrenal, and gonadal functions were improved in 14% (three of 22), 41% (19 of 46), 11% (ten of 87), were unchanged in 82% (100 of 122), 77% (97 of 126), 89% (102 of 115), and worsened in 15% (19 of 22), 8% (ten of 126), 3% (102 of 115), respectively. Permanent diabetes insipidus occurred in 5% (seven of 126). Two patients died during the immediate postoperative period. The recurrence rate in patients with a mean follow-up of 6.4 +/- 4.2 years was 21% (15 of 71). These data indicate that trans-sphenoidal microsurgery is an effective and safe initial treatment for patients with nonsecreting pituitary adenoma and may reverse hypopituitarism.

Adenoma↗

PubMed2002

Real-time measurement of blood vessel occlusion during microsurgery.

Measurement and feedback of vascular properties during microsurgery is generally not available. We carried out real-time in vivo measurement and analysis of microsurgical occlusion of 1-2-mm diameter arteries and veins in rodents. A pair of forceps mounted with strain gauges was designed for applying and directly measuring the force on tissue. Forces between 0 and 450 mN were applied, with the device having a resolution of 0.5 mN. We performed in vivo experiments on the rat femoral (n = 5) and abdominal (n = 8) blood vessels to measure the elastic restoration force of the tissue in response to radial compression at different levels of force. On average, the minimum occlusion force was 57 mN for the rat artery. During steady application of force, the perturbations in the blood vessel due to heartbeat are visible in the force data. These force oscillations ranged between 1 and 3 mN around the mean steady-state force applied. It was determined that the magnitude of the Fourier spectral peak corresponding to heartbeat frequency can be used as a measure of the patency of the blood vessel, and can provide feedback to microsurgeons to avoid damage to the vessel by application of excess force.

Animals↗

PubMed1987

Experimental study of CO2-laser-induced histological effects on human fallopian tube: determination of CO2 laser parameters to be used in microsurgery.

This experiment investigates CO2-laser-induced histological effects on fallopian tubes obtained during hysterectomies in women. Tubal transversal sections were performed at isthmic and ampullar sites. Forty strips were available for histological study of the cut section area. The role of different parameters such as radiation power and beam fractionation (continuous versus pulsed) on tissue lesions was assessed. In tubal microsurgery, the CO2 laser can be used as a scalpel with the predominant advantage of minimal tissular alterations. As a result of this study, our recommended parameters are the following: radiation power, 7-10 W; beam focalization zone, 0.2 mm; energy density, 20,000-35,000 W/cm2; continuous operation; moving speed, 1 cm/s.

Carbon Dioxide↗

PubMed1987

Laser microsurgery in oncology: indications, techniques, and results of 5-year experience.

Multidisciplinary collaboration has enabled us to use the CO2 laser in many different surgical fields. The 5-year experience at the National Tumor Institute of Milan is reviewed for the evaluation of short- and medium-term results of 321 laser surgical operations of the lower genital tract, 475 cases of lesions of the larynx and oral cavity, and 246 cases of skin lesions. A unified approach was used as regards safety measures, preoperative evaluation, and rules of application of laser instruments. The reliability of the surgical procedures, the proper selection of the cases, and the low rate of postoperative complications allowed outpatient treatment in 76% of the cases, thus reducing the hospitalization costs. The use of the microscope for laser resections under magnification was recognized to be preferable in routine surgical oncology practice. Short- and medium-term clinical results with laser microsurgery were comparable to those with conventional surgery, especially when precise and conservative removal of periorificial lesions was required.

Equipment Safety↗

PubMed1994

Intraocular microsurgery with a picosecond Nd:YAG laser.

We investigated the use of picosecond Nd:YAG laser pulses for intraocular microsurgery. With a pulse duration of 100 picoseconds, only 70 microJ of pulse energy is required to consistently produce optical breakdown in the deep vitreous. This pulse energy is nearly two orders of magnitude less than the typical pulse energies used in conventional (nanosecond) photodisruptors. The reduced pulse energy results in a smaller zone of tissue damage, an important consideration when operating close to the retina or other sensitive ocular structures. Efficient cutting action is achieved by applying multiple pulses at a moderately high repetition rate of 50-200 Hz. An in vitro model was developed to assess axial confinement of picosecond photodisruption. In vivo vitreous membrane surgery was performed in experimental rabbit eyes to demonstrate a potential clinical application of picosecond laser-induced optical breakdown.

3T3 Cells↗

PubMed2003

Microsurgery simulators in virtual reality: review.

Surgical training is undergoing a rapid transformation, which has been influenced by advances in computer modeling. Increased pressure to reduce the use of animals in technical training has led to a new approach in teaching microsurgery. This new technology may prove to be a cost-effective, portable, and nonhazardous way forward in microsurgical training. This paper reviews the current state of available technological models used in microsurgical training. In doing so, we review articles from the latest journals and authenticated Internet websites to compare and contrast these various methods. Finally, we look at the specific technique that has potential impact on the future modeling of microsurgical techniques.

Computer Simulation↗

PubMed2001

Video microsurgery: early experience with an alternative operating magnification system.

Since Nylen first used an operating microscope in 1921, its basic design has remained fundamentally unchanged. Microsurgical procedures are still performed while viewing the subject through binocular eyepieces. This article examines the potential to perform microsurgery using video technology, operating with a television monitor. The development of the videomicroscope is discussed together with its early trials. The results show the potential to perform simple microsurgical procedures while viewing the procedure in a two-dimensional format. The advantages and disadvantages of such a system are discussed, together with future implications.

Humans↗

PubMed2001

Basic teaching in microsurgery.

We summarize our 15 years of educational experience in the field of teaching microsurgery. The students can be divided into three groups: (1) medical students, (2) researchers, (3) medical doctors and specialists. Characteristics of our method include the following: activity, synchronism, video-assistance, self-controlling, individualization, analysis. The Furka microsurgical educational method, named after one of the authors, is 20 hours long (five 4-hour sessions). The first lesson allows students to become acquainted with the microsurgical instruments. The next lesson consists of learning the probe of layer-feeling. The third lesson is to learn how to produce stitches under the microscope. The fourth lesson includes arterial anastomosis preparation on fresh arterial pieces of animal origin. The fifth lesson means a quality change from previous classes, as practice is performed on living animals, generally rats. The teaching of microsurgical basics requires both patience and empathy. The teaching process is most successful if one teacher deals with a maximum of two students.

Animals↗

PubMed1984

Experimental foetal microsurgery as related to myelomeningocele.

To study this capacity of embryono-foetal tissue to regenerate without scar formation, experimental intrauterine surgery has been carried out in rabbits. This study has been performed with regard to the possibility of using intrauterine microsurgery to correct myelomeningocele in humans to avoid scar adhesion between the medulla and the growing vertebral bones and subsequent hydrocephalus. Lesions were produced in the spinal cord of rabbit foetuses, and observation after birth showed repair without scar formation. Further research is in progress to confirm these findings and to adapt this procedure to the clinical situation.

Animals↗

PubMed1984

A training card for microsurgery.

A training card for microsurgery is described which could be useful for beginners. The card is light in weight, inexpensive to produce, easy to use, and can be preserved as a record of progress.

Education, Medical, Continuing↗

PubMed1985

Relationship of costs and real advantages of microsurgery in urology.

The cost-advantage relationships in the use of microsurgical equipment and techniques in various medical fields are examined. Cost-effectiveness in clinical urology appears to support the use of microsurgery. Specific applications to urethroplasty, pyeloplasty, renal stone surgery, and renal trauma, are discussed.

Adolescent↗

PubMed1988

Epididymal microsurgery: current techniques and new horizons.

Surgical treatment for obstructive azoospermia was introduced about 30 years ago with the development of Bayle's vasoepididymal fistula technique (Bayle: Enc Med Chir 41:435, 1966). More recently this has been replaced by single tubule end-to-end microvasoepididymal bypass procedures with improved success rates. We describe the use of animal models in the development and application of a modified end-to-end microanastomosis technique in which the vas deferens is attached to a single surface convolution of the ductus epididymidis. In comparison with other microvasoepididymostomy (micro-VE) procedures, this technique results in less postoperative scarring and allows for easier access to the epididymis in those patients requiring subsequent epididymal surgery. With this procedure 60% of patients produced spermatozoa after operation, and 10% of 102 patients have so far achieved pregnancies. For patients, such as those with congenital absence of the vasa deferentia, whose infertility cannot be corrected by microvasoepididymal surgery, we describe a microaspiration procedure that can be used to collect spermatozoa from the epididymis for use in in vitro fertilization (IVF). This procedure has a low success rate at present, with an 18% fertilization and 3% pregnancy rate per cycle. Improvements in treatment procedures for aspirated sperm samples, such as the use of motility stimulators and in vitro maturation by coculture with epididymal tubule segments before IVF, may enhance the success for this technique. Microinjection of sperm collected by epididymal microaspiration into oocytes may be an alternative method of treatment for these patients in the future. Two procedures (microepididymoepididymostomy and the vas bridge bypass) that are currently being modelled in the rabbit may provide new directions for epididymal microsurgery and for examining epididymal function. Although the two methods are technically more difficult than standard micro-VE procedures, preliminary studies are encouraging and suggest a future role for these techniques in treating obstructive azoospermia. Such techniques make use of the epididymis distal to the obstruction site and may be particularly important in improving the success of surgery for obstructive azoospermic patients with high-level obstructions in whom sperm quality following micro-VE surgery is often poor.

Anastomosis, Surgical↗

PubMed1989

Advances in otologic microsurgery.

Recent advances in otologic microsurgery have brought progress in the improvement of hearing impairment, alleviation of vertigo, and removal of skull base tumors. Refinement of stapedectomy techniques, use of new biocompatible prostheses, and other advances promise improved results with established otologic procedures. In addition, implantable hearing aids and cochlear implants will increasingly improve hearing in patients who previously could not be helped. The surgical methods for vestibular nerve section continue to be refined to help the surgeon and minimize risk to the patient. The challenging new field of skull base surgery has been opened through the combined efforts of otologists and other specialists. The recent advances in these fields are reviewed.

Ear, Inner↗

PubMed1993

The cephalic vein in microsurgery.

A working knowledge of the venous anatomy is seldom emphasized but is an essential element in all microvascular procedures. The cephalic vein has been chosen here to serve as a model, since it is an important source for both afferent and efferent flow for flap transfers as well as in limb replantations. The better known, lower extremity superficial veins, especially as a source for long vein grafts, are not necessarily the best option. The cephalic vein represents the most versatile of the large superficial veins of the upper extremity and has numerous roles in microsurgery other than as a viable alternative for vein grafts.

Arm↗

PubMed1994

Use of the latissimus dorsi flap in head and neck reconstructive microsurgery.

Reconstructive surgery of the head and neck has particularly benefited from the rapid developments in microsurgery. Resection of tumours from the head and neck which are associated with serious physical and psychological problems, or which often require multiple reconstructive procedures, can now be performed as a single-stage procedure with good oncological and functional results. The present series reports on the treatment of 12 primary or recurrent malignant tumours of the head and neck using the latissimus dorsi musculocutaneous free flap. Complications consisted of two venous thromboses which required revision of the anastomoses. The oncological and functional results were good, while the aesthetic outcome was fair. We conclude that the latissimus dorsi muscle or musculocutaneous free flap is the method of choice to repair wide defects of the head and neck following the resection of malignant tumours.

Basal Cell Carcinoma↗

PubMed2005

Microsurgery in microgravity is possible.

The aim of this experiment was to evaluate the feasibility of a microsurgical procedure in the context of microgravity during parabolic flights. The surgical procedure included the sectioning and repair of a rat sciatic nerve and tail artery with 10/0 monofilament sutures. Both procedures were successful. To date, telesurgery cannot be considered during interplanetary spaceflights. If a surgeon is able to perform microsurgery in microgravity, a physician with basic surgery training will be able to perform basic surgical procedures in space flights.

Animals↗

PubMed2005

Convergence insufficiency: a treatable cause of problems in microsurgery.

Microsurgical training concentrates on the practical mechanisms of performing vessel anastomoses, with little attention given to medical problems that may adversely affect the trainee's performance. Undiagnosed vision problems are rarely considered in microsurgical training, and may not be manifested until other limiting factors, such as basic instrument and suture handling, are mastered. While vision problems tend to be diagnosed and treated immediately among ophthalmology trainees, visual and ocular pathology is poorly understood outside of that specialty. We present a case of a surgeon who had been performing microsurgery for 10 years with an undiagnosed binocular vision problem that consistently affected microsurgical proficiency. Once diagnosed, the problem responded to therapeutic exercises within weeks. We suggest ophthalmologic referral of any surgeon who has unexplained problems with microsurgical technique (especially problems involving stereoscopic vision) to exclude a treatable visual cause.

Adult↗

PubMed2002

Lymphedema and microsurgery.

Lymphedema is often diagnosed by its characteristic clinical presentation. In some cases, however, instrumental investigations are necessary to establish the diagnosis, particularly in early stages of the disease. One of the primary problems for microsurgery in treating lymphedema consists of the discrepancy between the excellent technical possibilities and the insufficient results in reduction of lymphedematous tissue fibrosis and sclerosis. Long-term results indicate that microsurgical operations have a valuable place in the treatment of obstructive lymphedema (primary or secondary) and should be the treatment of choice in these patients. Improved results can be expected with earlier microsurgical operations because patients referred earlier usually have less lymphatic disruption and fibrotic tissue. Advanced diagnostic methods and improvements in operation techniques have modified indications for surgical therapy of lymphedema. This article systematically reviews the published literature on the microsurgical treatment of lymphedema to the present.

Animals↗