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Results for “Surgical Performance”

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PubMed2004

Surgical disobliteration of postthrombotic deep veins--endophlebectomy--is feasible.

OBJECTIVE: Partial obstruction of postthrombotic veins is caused by endovenous scar tissue, which creates synechiae and septae that narrow and sometimes block the lumen. We have performed surgical disobliteration, or endophlebectomy, of chronically obstructed venous segments during various kinds of deep venous reconstructions to increase the flow through previously obstructed segments. In this article we describe the endophlebectomy technique, and report the availability of this procedure as an adjunct to deep venous reconstructions for the treatment of postthrombotic chronic venous insufficiency. Patients and methods Between July 1996 and February 2003, surgical disobstruction of 23 deep venous segments was performed in 13 patients in association with 14 deep venous reconstructions to treat advanced postthrombotic chronic venous insufficiency. Postthrombotic veins were surgically exposed, and a longitudinal venotomy was carried out at a variable length. The synechiae and masses attached to the intimal layer were carefully excised. Mean duplex scanning follow-up was 10.8 +/- 8.2 months (median, 8 months; range, 1-28 months). RESULTS: In 10 patients (77%) the treated segments remained primarily patent at median follow-up of 8 months (range, 1-28 months). Early thrombosis near the endophlebectomy site occurred in 3 patients, at 2, 5, and 12 days, respectively, after surgery. In 2 patients with early thrombosis further interventions were carried out with success. In a third patient with early postoperative thrombosis the final outcome was recanalization and reflux. These results yielded an overall secondary patency rate of 93%. No perioperative pulmonary embolism was observed. CONCLUSION: This series demonstrates that surgical disobliteration of postthrombotic deep veins is technically feasible, and led to patency of the segments for the duration of follow-up for up to 28 months (mean, 10.8 +/- 8.2 months). We used this technique with the objective of disobstructing postthrombotic veins, to increase flow through a previously narrowed lumen. Postoperative thrombosis at the site of endophlebectomy occurred in 23% of patients. Although this early experience is encouraging, further studies and longer follow-up are necessary to assess the durability of the procedure.

Feasibility Studies↗

PubMed2006

Occupational exposures to bloodborne pathogens among healthcare workers in Rio de Janeiro, Brazil.

Healthcare workers (HCWs) frequently face the risk of occupational infection from bloodborne pathogens following exposure to blood and body fluids. This study describes the results of a surveillance system of occupational exposure to bloodborne pathogens among HCWs in Rio de Janeiro, Brazil, during an eight-year period. A total of 15 035 exposures reported from 537 health units were reviewed. Six circumstances comprised nearly 70% of the reported exposures: recapping needles (14%), performing surgical procedures or handling surgical equipment (14%), handling trash (13%), during disposal into sharps containers (13%), performing percutaneous venepuncture (10%) and during blood drawing (5%). Easily preventable exposures, such as incidents related to recapping needles, handling trash, and sharps left in an inappropriate place, represented 30% of the exposures reported. Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) was initiated for 46% of exposed HCWs. Although Brazilian guidelines indicate that PEP is usually not recommended for exposures with insignificant or very low risk of HIV infection, PEP was prescribed to a large proportion of exposed HCWs under these circumstances. The prevention of occupational exposure to bloodborne pathogens among HCWs and their safety must be considered as a public health issue. Although infection-preventative measures such as antiretroviral drugs and rapid tests are available, this study shows that there are still a high number of easily preventable exposures. The implementation of more effective prevention strategies is urgently required in this country.

Adult↗

PubMed1998

Robotic surgery in urology.

The demand for improved surgical performance and reduced health care costs have led to the evaluation of surgical robotic systems. Robotic devices to assist urologists with transurethral resection of the prostate, percutaneous renal access, and laparoscopy are currently in development or are already in clinical use. The rapid advances made in telecommunication technology also have allowed for the development of telesurgical systems that permit surgeons to participate in surgery from a remote location. In the twenty-first century, surgical robots will be efficient, invaluable, and safe adjuncts to urologic practice.

Humans↗

PubMed1999

Successful replantation of penile amputation (post-circumcision) complicated by prolonged ischaemia.

Circumcision is one of the most commonly performed surgical procedures. Whereas, in modern Saudi Arabia, the majority of circumcisions are performed in a hospital set-up, traditional ritual circumcisions are still performed in the community. We report a case of a 4-year-old boy with amputation of the penis after ritual circumcision. Replantation was successful despite an ischaemia time of 18 h.

Amputation, Traumatic↗

PubMed2002

[The surgical treatment of traumatized eyes with no light perception].

OBJECTIVE: To assess the efficacy of surgical treatment for traumatized eyes with no light perception (NLP). METHOD: We performed surgical treatment of vitrectomy on 11 eyes with NLP of 11 patients. The patients with LP or more than LP after the operations were followed up from 6 to 24 months (mean, 11 months). RESULTS: Postoperatively, 7 of 11 patients had visual acuities of light perception to 0.2. Four remained NLP, in which one had enucleation. CONCLUSIONS: The serious opacity of refractive media, the damaged or detached retina and the choroid edema are the main reasons of NLP. Some patients of NLP may get some visual acuities after surgical treatment of vitrectomy.

Adult↗

PubMedDate not supplied

[Palliative treatments in obstructive jaundice due to periampullary neoplasms].

OBJECTIVE: The evaluation of the palliative procedures, surgical and endoscopical or radiological, in the treatment of patients affected by obstructive jaundice resulting from periampullary tumors. SUBJECTS: Patients with jaundice by periampullary tumors undergoing to surgery or to endoscopical or radiological procedures from january 1987 to april 1998. RESULTS: Jaundice has come down in all patients after surgery. Mortality after surgery was 5.2% (5.9% in geriatric patients); morbidity 15.8% (17.6% in geriatric patients) survival 10.4 months after surgery (8.8 months in geriatric patients) versus 3.1 months after non surgical procedures. DISCUSSION: In all patients periampullary tumors are more frequent than hepatic hilum and common bile duct tumors. We have performed surgical and not surgical palliative procedures more frequently than curative resection (DCP), especially in geriatric patients (94.5% versus 79%). In geriatric patients we have chosen, between bile-digestive by-passes, the cholecysto-jejunal anastomosis because it is easier and faster to carry out than choledochojejunal anastomosis with the same results as well as from literature data. We have always performed a gastroenteric anastomosis in association with palliative surgical procedures to prevent or to solve a duodenal obstruction. This additional treatment didn't show an increasing of mortality and morbidity as well as from literature data. CONCLUSIONS: We have reserved the palliative non surgical procedures only to high surgical risk patients. In the other cases we have chosen palliative surgery for better long-term results and quality of life in the general series patients as well as in geriatric patients.

Aged↗

PubMed2005

Techniques for performing tracheostomy.

One of the most commonly performed procedures in the critically ill, tracheostomy has been described and used for lifesaving treatment of upper-airway obstruction for at least 3,500 years. The procedure can be performed surgically in the operating room or at the bedside in the intensive care unit. Recently, percutaneous techniques performed by a variety of specialists have become popular alternatives to open surgical tracheostomy. Various devices have been developed to minimize identified risk and improve the simplicity of the procedure. These techniques and devices are described in this paper.

Bronchoscopy↗

PubMed2004

Surgical treatment for abnormal echoes in the left ventricular outflow tract caused by ruptured mitral chordae tendineae.

We performed surgical treatment for abnormal echoes in the left ventricular outflow tract caused by ruptured mitral chordae tendineae. An asymptomatic 68-year-old man had a chordal rupture exhibiting a tumor-like lesion in the left ventricular outflow tract on echocardiography. Considering a high level of mobility of the tumor as well as its texture, the risk of embolization was found to be significant. Therefore, it was decided on the surgical resection of the tumor-like lesion under extracorporeal circulation. We report a highly rare case of rupture in redundant mitral chordae tendineae without mitral regurgitation, revealed by uncommon echoes in the left ventricular outflow tract during systole.

Aged↗

PubMedDate not supplied

[Surgical treatment of eye injuries in five-year survey period].

INTRODUCTION: Eye injuries represent one of the biggest problems in eye surgery all around the world, including our country. Treatment of eye injuries demands highly skilled personnel and adequate technical equipment. OBJECTIVE: To show a total number of eye injuries, including the surgical methods used for their treatment. METHODS: In our study, retrospective analysis of all performed surgical methods used in treatment of hospitalized patients in our Clinic during 2000-2004 was carried out. A special attention was paid to pars plana vitrectomy, together with combined anterior-posterior segment procedures. RESULTS: During 2000-2004, a total of 347 pars plana vitrectomy, and 27 traumatic retinal detachments (conventional methods) were performed. In addition, 314 patients with contusion trauma of the eyes were treated. Out of 297 patients with penetrant eye injuries, 196 (66%) had intraocular foreign bodies (IOFB), and 101 (34%) were without IOFB. A total number of endophthalmitis was 34 (8.73%). The number of combined anterior-posterior segment operations during this period was 227. CONCLUSION: Vitreoretinal operations are the most prevailing in treatment of serious eye injuries. Pars plana vitrectomy is also the most common method of surgical treatment of eye injuries.

Eye Injuries↗

PubMed2005

Surgical skill is predicted by the ability to detect errors.

BACKGROUND: Objective analysis methods of surgical performance are now available so comparison between surgeons is available. One such method is by direct observation using the Objective Structured Assessment of Technical Skills (OSATS), but this is a time-consuming process; therefore, a simple screening tool for the ability to detect errors (previously validated) was analyzed and considered as a predictor of qualitative performance. METHODS: Thirty-eight volunteer surgeons were recruited to the skills laboratory to undertake 3 exercises. Two were bench-top surgical tasks that were scored using the global rating of the OSATS technique. The third task was the ability to detect simple errors in 22 synthetic models of common surgical procedures, some of which contained purposefully made errors. P<.05 was deemed to be statistically significant. RESULTS: The scores (interquartile ranges in parentheses) for the 3 sections were excision of sebaceous cyst=21 (19,24), closure of small bowel enterotomy=23 (21,27), and identification of errors=31 (27,34). Three scorers blinded to the operative models exhibited an interobserver reliability of .9 and .91 for the video tasks, respectively. Spearman's rank correlations between the error examination and performance on the 2 tasks were both statistically significant at .69 (cystectomy) and .54 (enterotomy). CONCLUSIONS: The ability to detect simple surgical errors is a predictor of technical skill and performance of bench tasks. What must be answered is whether the use of such models and principles can shorten the qualitative surgical learning curve.

Clinical Competence↗

PubMed2001

Spatial ability and learning the use of an angled laparoscope in a virtual environment.

Little is known about the cognitive demands that underlie surgical performance. Several studies have suggested that spatial ability plays a substantial role in surgical skill. An example of a skill in which spatial cognition appears to be of importance is the use of the angled laparoscope. This paper describes a virtual environment designed to assess and train the use of the angled laparoscope. The learning rates of novices learning the skill for the first time in the virtual environment were measured. The rates were found to be highly variable and strongly correlated with spatial ability.

Adolescent↗

PubMed1982

The Cincinnati incision: a comprehensive approach for surgical procedures of the foot and ankle in childhood.

We are describing a transverse incision that we have found useful in performing surgical procedures involving extensive dissection of the posterior, medical, and lateral aspects of the foot and ankle. Operative procedures using this incision have been performed on 154 feet in ninety-nine patients who were less than fifteen years old and who had an average follow-up of eighteen months. The incision is transverse and extends from the anteromedial to the anterolateral aspect of the foot over the back of the ankle at the level of the tibiotaler joint. Depending on the requirements of the procedure, either the anteromedial or posterolateral portion of the incision, or the complete incision, may be used. The incision improves visualization of the medial, posterior, and lateral aspects of the foot and ankle, while at the same time resulting in excellent healing of the wound and an improved cosmetic appearance compared with the more commonly used vertical incisions.

Adolescent↗

PubMed1998

[Bronchoscopically controlled percutaneous puncture tracheotomy].

With extending duration of translaryngeal intubation the rate of lesions in the oral cavity, pharynx and trachea caused by the orotracheal tube increase. To prevent these complications ventilated patients receive early tracheostomy. PDT is an alternative procedure to the conventional, surgically performed tracheostomy. We performed 60 dilatational tracheostomies using the Ciaglia percutaneous tracheostomy set (W. Cook-Critical Care, Bjaeverskov). Complication rate was 17% due to minor bleeding (n = 7), subcutaneous emphysema (n = 2) and fracture of one tracheal cartilage ring (n = 1). This rate is equivalent to that of surgical procedure. Advantage of PDT is that it can be performed by intensive care doctors without a specific surgical background. Further follow up after removal of the tracheal cannula was uneventful. Tracheal stenosis requiring intervention are rare. The remaining scar after PDT is significantly smaller than after conventional tracheostomy.

Adult↗

PubMed1995

Gallbladder motility, gallstones, and the surgeon.

Cholecystectomy is one of the commonest surgical procedures in the Western world, with more than half a million procedures performed annually in the United States alone. In recent years, studies of gallstone pathogenesis and gallbladder disease have increasingly focused on abnormal gallbladder motility in the pathogenesis of some, if not all, gallbladder conditions. The control of gallbladder motility is complex and depends on an intricate interplay of neural and hormonal factors. An understanding of the control of gallbladder motility is crucial to the understanding of the mechanisms of gallstone formation and may help to explain the failure to cure symptoms after cholecystectomy in up to one third of patients. The purpose of this article is to outline mechanisms controlling gallbladder motility, examine recent developments in our understanding of this complex process, and relate changes in motility to common disease conditions of the gallbladder. The role of altered motility in the pathogenesis of gallstones is discussed and the effects of commonly performed surgical procedures such as truncal vagotomy and cholecystectomy on upper gut physiology are reviewed.

Cholecystectomy↗

PubMed2006

Common aortic arch anomalies: diagnosis and management.

Vascular rings are a rare form of congenital malformation that completely encircle the trachea and esophagus with vascular structures. The two most common forms are double aortic arch and right aortic arch with an aberrant left subclavian artery and a left-sided ligamentum arteriosum. Patients may present with symptoms of airway or esophageal impingement, including "noisy breathing," stridor, respiratory distress, difficulty feeding, or dysphagia. Typically, the more severe the airway or esophageal compression, the earlier the age at presentation. Diagnosis was traditionally made by posterior compression of the esophagus demonstrated by barium swallow; in the current era, CT angiography or magnetic resonance angiography is used. Although helpful to delineate intracardiac anatomy and associated structural heart defects, echocardiography is less useful for imaging vascular structures when atretic segments comprise part of the vascular ring. Management includes surgical division of the structures contributing to the vascular ring. Some centers also perform surgical remodeling of Kommerell's diverticulum because this structure may contribute to continuing tracheal or esophageal compression even after the ring has been released. Patients with associated tracheomalacia may continue to have symptoms that can last for months, but ultimately resolve with time. Long-term results are generally excellent with minimal morbidity and mortality.

Journal Article↗

PubMed1990

[Clinical value of new rapid nuclear magnetic resonance tomography in preoperative assessment of hypernephroma. A prospective comparative study of CT and MR].

The new technique of rapid magnetic resonance imaging (MRI) with a paramagnetic contrast agent provides excellent imaging of the kidneys and their lesions. MR imaging of this anatomical region at short breath holding intervals matches the well-known quality of computed tomography (CT) for the first time. MR and CT studies were performed on 36 patients with proven renal cell carcinoma. Different investigators evaluated the staging of the tumor by means of both techniques in a prospective study. In all patients a radical nephrectomy was performed. Surgical and pathological findings were compared. Though little difference was found in diagnostic value between the two systems, MRI results concerning the T-stage were better. Venous invasion was clearly shown by MRI without the use of contrast medium. Furthermore, sagittal and transaxial images provided a more direct assessment of the extent of the tumor and its demarcation to healthy parenchyma. Thus, MRI is helpful in planning of the surgical approach when organ-sparing excision of renal tumors is to be performed.

Adrenalectomy↗

PubMed1996

[A case of cerebral aspergillosis associated with induction chemotherapy for acute lymphoblastic leukemia].

A case of cerebral aspergillosis during induction chemotherapy for acute lymphoblastic leukemia was described. A 5-year-old boy complained of headache and left homonymous hemianopsia during induction chemotherapy for acute lymphoblastic leukemia. CT scan and MR imaging survey demonstrated cerebral fungal lesion as well as multifocal lung lesions. A cerebral lesion appeared as a low density mass in right occipital lobe with marginal enhancement on CT scan, and iso- and high-signal intensity appeared with marginal gadolinium enhancement on T1- and T2-weighted MR imaging. Although fungus balls in the lung responded well to daily intravenous administration of amphotericin-B for 2 months, the cerebral lesion showed a rather expansive character as invading into neighbouring falx, opposite occipital lobe, meninges, and occipital bone. Extensive removal of the brain lesion from the parenchyma, falx, invaded dura, and skull was surgically performed. The lesion was confirmed as aspergillosis by Grocott's methenamine histological stain. Surgical intervention and concomitant use of amphotericin-B for a month resulted in complete remission of the aspergillosis. After 6 years, a cranioplasty was successfully completed for the occipital bone defect.

Amphotericin B↗

PubMed2003

Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine.

OBJECT: There have been significant improvements in neurovascular technology and implants over the past decade. One such material, N-butyl cyanoacrylate (NBCA), is now commercially available for cerebral arteriovenous malformation (AVM) embolization in the US. An ethylene vinyl alcohol copolymer preparation, Onyx, which is currently being evaluated, is approved for use outside North America. Although reports indicate that Onyx may be superior to NBCA from an endovascular perspective, little information exists about its surgical handling characteristics. The purpose of this study was to compare the surgical handling characteristics of Onyx-treated vessels with those of NBCA-embolized vessels in an AVM resection model. METHODS: Fourteen pigs (two groups of seven) were anesthetized. A femoral artery was cannulated, followed by selective catheterization of the ascending pharyngeal arteries. Nidal rete mirabile (RM) embolizations were performed using either 6% Onyx or 20% NBCA. After angiographically confirmed obliteration of flow in the right RM, microsurgical resection of this structure was performed. Surgical handling characteristics of the embolized RM were rated on a scale of 1 to 5 and blood loss was recorded. Different surgeons performed the embolizations and resections. The surgeon who performed resections was blinded to the embolization agent used, and the data analysis was also performed in a blinded fashion. The surgical handling scores were superior (p < 0.05) in the Onyx-treated group. Although there was also less blood loss in this group, the difference was not significant. Subjectively, the surgeon who performed the resections believed that Onyx was softer and handled better than NBCA. CONCLUSIONS: Onyx, which may offer endovascular advantages, also seems to provide benefits for the surgeon.

Animals↗