SEARCH · PubMed Health

Results for “Microsurgery”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources

PubMed1999

[Transnasal microsurgery using a micro-pressure-suction-irrigation system for pituitary adenomas].

Micro-pressure-suction-irrigation system (MPSIS), introduced by Luedecke et al, is an instrumentation for the direct transnasal pituitary procedure. We improved this system for use in Japan. The irrigation system can effectively clean the operating field by one-hand manipulation and dissect tumor tissue by its rapid flow. The pressure of suction and irrigation can be adjusted respectively by a device in the handpiece. The MPSIS is applicable to different stages of intervention because it is equipped with separate tips of various diameters, lengths and angles. This system is especially useful in combination with a micromirror or an endoscopy for direct inspection of the eccentric tumor sites such as the cavernous sinus, the upper part of the planum sphenoidale, or the posterior suprasellar regions. The use of the MPSIS helps to avoid injury to normal tissue structures, and prevents tiny soft microadenoma from being lost during preparation. We have proved the suitability and usefulness of the MPSIS in 23 surgical interventions for transnasal microsurgery of pituitary adenomas.

Adenoma↗

PubMedDate not supplied

How to do it in surgery: transanal endoscopic microsurgery.

Transanal endoscopic microsurgery has been performed in our institution since 1993 (Curran et al, 1994). It involves the use of a specially designed operating sigmoidoscope to excise benign and early invasive tumours from the rectum. It allows for accurate dissection of these lesions ensuring safe and complete excision with histological confirmation of this.

Anus Neoplasms↗

PubMed1999

Role of microsurgery in the management of lymphoedema.

BACKGROUND: Microsurgical techniques in the treatment of peripheral lymphoedema proved to be very promising, the authors' clinical experience with derivative and reconstructive lymphatic microsurgical operations was analysed. METHODS: From 1973 to 1997, 843 patients were studied and treated by microsurgical methods, with average follow-up of over 5 years. Microsurgical techniques mostly consisted of derivative lymphatic-venous or lymphatic-capsule-venous anastomoses and reconstructive autologous vein interpositioned grafts (lymphatic-venous-lymphatic-plasty). Ninety percent of patients were operated on at the II-III stage, 3% at the I and 7% at the IV-V stage. Limb volumes were measured using the water displacement technique and lymphoscintigraphy was used to accurately assess the structural and functional status of the lymphatic drainage before and after variable distances of time after microsurgery. More recently, also lymphangio-MR was used to accurately evaluate changes in the lymphoedematous extremity before and after treatment. RESULTS: Postoperatively, all the patients had a reduction of oedema variable above all according to the stage of the pathology at the time of microsurgical operation. Short and long-term results were positive, as concerns both volumetric oedema reduction and arm function, besides the regression of annual incidence of acute lymphangites. The efficacy of microsurgical lymphatic operations has been verified, moreover, by lymphoscintigraphy. CONCLUSIONS: Microsurgical techniques permit, today, the solution of complex clinical patterns not only of secondary but also of primary, unilateral and bilateral, lymphoedemas, at different stages, with better results the more precocious the microsurgical treatment is, with stabilization of the result also at long distance of time from operation.

Adolescent↗

PubMed1999

[Microsurgical results of paraclinoid aneurysms of the internal carotid artery: microsurgery versus intravascular surgery].

Since paraclinoid aneurysms exhibit considerable variations in the surrounding skull base structures, some skill and experience are considered essential for their microsurgical treatment. On the other hand, intravascular coil embolization would be free from these extravascular factors. Fifty-two aneurysms in 48 patients were treated microsurgically. They were divided into an early series treated before 1995 and a late series treated after 1996. Three aneurysms in 3 patients were treated by intravascular surgery. Preoperative neuroimages, topographic anatomy and surgical results were compared retrospectively. The results in the microsurgical late series were better than those in the early series. While 89% of the patients exhibited excellent results with two patients left with partial visual field defect (7%) and one death (3%) in the early series, the rates in the late series were 95%, 5% and 0%, respectively. Complications and failure in neck clipping were considered to be due to such topography as, 1) C3 aneurysms extending into the anterior clinoid process, 2) multiple aneurysms, 3) ophthalmic artery originating near the dome, 4) atheroma or calcification at the neck, 5) marked medical shift of C2 segment, and 6) tight adhesion of the dural ring to the dome. Coil embolization was successful in two aneurysms, while it was given up in one. We currently propose that intravascular surgery is indicated for cases 1), 4), 5) and 6), and microsurgery would be more advantageous for cases where the neck is broad and where the topography concerning aneurysmal multiplicity or the branching site of the ophthalmic artery is not fully understood by preoperative imaging.

Aneurysm↗

PubMed1999

Microsurgery costs and outcome.

Reliable information on cost and value in microsurgery is not readily available in the literature. Driving factors for cost, determinants of complications, and cost-reduction strategies have not been elucidated in this population, despite such progress in other areas of medicine. Clearly, the time-consuming and costly nature of this endeavor demands that appropriate indications and patient management be delineated; to operate proactively in this cost-conscious time, financial and outcome determinations are critical. One hundred seven consecutive free-tissue transfers performed from 1991 to 1994 by a single microsurgeon were studied. Retrospective chart review for clinical parameters was combined with analysis of hospital costs and professional charges. Operating room and anesthesia costs were based on a microcost analysis of actual operating room time, materials, labor, and overhead. Other patient level costs were generated by Transition 1, a hospital cost-accounting system. The following issues were addressed: (1) flap survival; (2) total costs and length of stay for all free flaps; (3) payments received from various insurers; (4) breakdown of operating room costs by labor, supplies, and overhead; (5) breakdown of inpatient costs by category; (6) additional costs of complications and takebacks; (7) factors associated with complications and flap takebacks; and (8) cost-reduction strategies. Mean free flap operating room costs (exclusive of professional fees) ranged among case types from $4439 to $6856 and were primarily a function of operating room times. Elective patient cases lasted a mean 440 minutes. There was a large disparity in reimbursement: private insurers covered hospital costs (not charges) completely, whereas Medicare paid 79 percent and Medicaid only 64 percent. Length of stay, operative procedures, and complications had the greatest influence on inpatient costs in this group of free flap patients. Potential cost savings as a result of possible practice changes (e.g., shortening intensive care unit stays and avoiding staged operations) can be predicted. This analysis has caused a revision in these institutions' practice patterns and lays the foundation for planned outcome studies in this population.

Adult↗

PubMed1999

[Transanal endoscopic microsurgery (TEM)].

Minimally invasive surgery is mandatory for rectal tumors to reduce surgical complications and to improve the quality of life. The conventional transanal procedure is one from of minimally invasive surgery for rectal tumors, but it is still often difficult to reach the middle and upper thirds of the rectum due to anatomical characteristics. Transanal endoscopic microsurgery (TEM) is a technique that allows radical resection of rectal tumors in the distal as well as proximal third of the rectum. Performing radical surgery using this technique requires preoperative estimation of tumor extension both histologically and by X-ray images. It should allow provide safe and radical excision of rectal tumors. In our department, patients with rectal tumors are evaluated for risk factors using barium enema, endoscopic ultrasound, punch biopsy, etc. Fifty patients (rectal cancer, 34: cartinoid, 4: adenoma, 12) have undergone radical TEM. The operation was converted to open surgery in 2 cases because of rectal perforation. Radical open surgery was performed after TEM in 1 patient since cancer invasion was revealed by postoperatively upon histological examination. We conclude that TEM is a useful technique for radical resection of rectal tumors and is associated with a low rate of postoperative complications and a high surgical success rate.

Anal Canal↗

PubMed1999

[Phoniatric remarks on microsurgery of vocal cords].

Own experience in microsurgery of vocal folds are presented. The necessity and importance of photographic and acoustic documentation (MDVP) as well as phoniatric pre- and postoperative rehabilitation are stressed.

Female↗

PubMed2000

[The use of microsurgery and balneotherapy in the treatment of hyperplastic laryngitis].

The study aimed at the assessment of the clinical value of using the combined method of laryngeal microsurgery and balneotherapy in the operative treatment and prevention of recurrences of limited hyperplastic changes of the laryngeal mucosa. The study material comprised two groups of patients diagnosed and treated in the years 1991-1997 in the Lublin E.N.T. Department and Laryngological Research-Consulting Center in Iwonicz Zdrój. The I clinical group consisted of 194 patients in whom, on definite indications, micro-surgeries with Kleinsasser's method were performed and the II control group consisting of 165 subjects suffering from chronic simple inflammation of pharyngo-laryngeal mucosa without morphologic hypertrophy. Inhalant treatment was performed by means of an individual method--using inhalant devices by Thomex L-2 producing high density mist of 1-4 mu degree comminution. Isotonic Iwonicz saline-Elin 7 was used. Uniform criteria of assessment were assumed and used of direct and distant therapeutic effect (in control studies) for the whole group of patients in the study period. Obtained results were analysed statistically.

Adult↗

PubMed2000

[Fifty years of plastic surgery in the Netherlands. VI. Microsurgery].

Use of the operating microscope created many new possibilities in plastic, reconstructive and hand surgery. Initially most work was done in digital replantation and, somewhat later, in transfers of toes for reconstruction of amputated thumbs. Microvascular surgery, however, appeared to be a technique suitable for more applications. Anatomical research of the blood supply of skin, fascia, muscle and bone identified flaps that could be carried by pedicle vessels. Transfer of these flaps and revascularization by microvascular anastomoses of the pedicle vessels set the stage for free flaps. In a few decades microsurgical techniques in plastic surgery fully matured. With free flap surgery single-stage and complex reconstructions could be achieved leading to earlier mobilization and better restoration of function with a shorter hospital stay. Today, microvascular free tissue transfer is an essential part of plastic and reconstructive surgery. Further advances in microsurgery and free tissue transfers deserve to be mentioned: pre-fabrication of free flaps, reduction of donor site morbidity, development of artificial conduits and instrumentation and finally homologous transplantations.

Hand Injuries↗

PubMed2000

Intraoperative tremor monitoring for vitreoretinal microsurgery.

An instrument for intraoperative sensing of surgeons' hand tremor during vitreoretinal microsurgery has been developed. The instrument uses inertial sensing to detect tremor in six degrees of freedom. Instrument tip velocity is computed using the sensor data. The displacement amplitude of the tremor is then approximated analytically by modeling the velocity as sinusoidal. The instrument presently estimates oscillations at physiological tremor frequencies with error of less than 7%.

Humans↗

PubMed2000

Local excision of rectal cancer by transanal endoscopic microsurgery (TEM) combined with radiotherapy: new concept of therapeutic approach.

Transanal endoscopic microsurgery (TEM), associated with preoperative radiotherapy in selected groups, allows minimally invasive full thickness local excision of rectal tumors with perirectal fat dissection. In our experience, 95 patients with extraperitoneal rectal carcinoma underwent TEM resection for T1 (21 cases), T2 (48 cases) and T3 (15 cases) lesions. In eleven patients the pathologist did not find cancer cells in the specimen (pT0) after full dose of radiotherapy and TEM. The postoperative results were as follows: 11 minor complications (11.6%), 7 leaking sutures, 3 stool incontinence and 1 rectal haemorrhage, that resolved with medical therapy and two major complications (2.1%), one rectovaginal fistula that required reoperation and one rectourethral fistula treated by conservative therapy. No perioperative mortality was observed. Mean follow up was 40 months (range 2-96 months) with 7 (7.4%) local recurrences. Of those, 5 patients were successfully retreated and 2 high risk patients underwent postoperative radiotherapy. The overall survival in T0 and T1 patients was 100%. The overall survival in T2 and T3 patients was 81% and 62.1% respectively. This study reports the application of TEM combined with radiotherapy in the treatment of rectal cancer in selected patients. This approach is feasible, safe, and appears to be effective at the present follow up, with preservation of normal sphincter function.

Adult↗

PubMed2001

Transanal endoscopic microsurgery.

Transanal endoscopic microsurgery, although technically challenging, offers a viable and perhaps superior outcome to radical abdominal or traditional transanal excision of rectal neoplasia. Appropriate training and case selection, as with any new technology, are mandatory to help ensure optimal results.

Equipment Design↗

PubMed1998

[Clinical observation and anatomical analysis of middle turbinate and ethmoidal internal wall moved to external side after microsurgery].

OBJECTIVE: To assess the effect of middle turbinate (MT) and ethmoidal internal wall(EIW) moved externally after microsurgery. METHODS: Twenty-four cases (45 sides) were followed-up endoscopically for (16.3 +/- 9.3) months. Thirteen cases (24 sides) were observed by CT scans. Three cadaver heads were measured for anatomical analysis. RESULTS: Forty-one (91%) of 45 sides obtained better olfactory function after operation. Twenty-two (91%) of 24 sides were found to have better CT changes in sinus ventilation as compared with preoperative CT scans. The gap between the MT and EIW to the orbital wall was (12.0 +/- 1.0) mm, while that between the ethmoidal bulla and processus uncinatus was only (2.3 +/- 0.6) mm as revealed in the autopsy. CONCLUSION: MT and EIW moderately moved suitably to externally had no bad effect on sinus ventilation, and it improved olfaction.

Adolescent↗

PubMed2001

[Implantation microsurgery in traumatic cataract].

ECCE with IOL implantation was applied to 41 eyes. In accordance with the trauma the eyes were divided in two groups: A--traumatic cataract after contusion trauma--5 eyes (12.20%) B--traumatic cataract after perforating trauma--36 eyes (87.80%). Three of the eyes from group B are with intra-ocular foreign body. A decision for implantation microsurgery is taken individually. Primary IOL implantation was applied to 26 of the eyes (63.41%) and secondary IOL implantation--to 15 of the eyes (36.59%). Only in 4 eyes anterior chamber IOL were implanted. In the other 37 eyes the implanted IOL were posterior chamber with fixation in the ciliary sulcus area. The final visual acuity was 0.5 and higher in 30 eyes (73.17%) and 0.8-1.0 in 11 eyes (26.83%). The primary or secondary IOL implantation in traumatic cataract is a reliable and effective method that helps to oppose amblyopy, to restore the binocular function and for the visual rehabilitation of the patients. This method gives the opportunity to achieve high values of the visual acuity with insignificant complications.

Adolescent↗

PubMed2002

Microsurgery for glioblastoma preserves short-term quality of life both in functionally impaired and independent patients.

OBJECTIVE: Considering the short remaining life expectancy with glioblastoma multiforme, numerous patients and their referring physicians are hesitant to use aggressive surgical treatment for fear of greater risk of neurological deterioration. The aim of our study was to determine whether surgical treatment of glioblastoma, utilizing modern microsurgical dissection techniques and tools, interferes with short-term quality of life. METHODS: The functional status before and after 67 microsurgical operations in 65 patients with glioblastomas was studied retrospectively. To evaluate the patients' quality of life, their functional neurological status was correlated with the Karnofsky performance scale (KPS). Post-operative evaluation was done within 7 days of surgery. RESULTS: No significant difference was found between the preoperative and the early postoperative functional status. Neither patient age nor the preoperative functional status determined a significant risk for postoperative functional deterioration. Patients with tumors involving so-called eloquent brain areas statistically worsened (p = 0.018); however, they showed only mild clinical impairment that was represented by a mean KPS status decline of less than -10. After total tumor resection, patients showed functional improvement. CONCLUSION: Microsurgery is safe and effective in order to improve or preserve short-term quality of life in glioblastoma patients. Total tumor resection is not associated with a significantly greater risk for neurological deterioration, either in patients with preoperative functional impairment, or in functionally independent patients.

Adolescent↗

PubMed2002

[Keyhole microsurgery for acoustic neurinomas through suboccipital retrosigmoid sinus approach].

BACKGROUND AND OBJECTIVE: Acoustic neurinomas is one of the most common benign tumor in central nervous system, the main treatment is surgical resection. This study is to explore keyhole surgery with suboccipital retrosigmoid sinus approach for acoustic tumor resection and discuss how to improve the surgical skill and effect. METHODS: Thirteen cases of acoustic neurinomas from Sept. 2000 to Dec. 2001 in our department were operated using keyhole craniotomy technique through unilateral modified suboccipital retrosigmoid approach with "[symbol: see text]" incision. All patient underwent suboccipital craniotomy in order to maintain anatomical replacement, and the tumors (2.0-4.4 cm in diameter) were removed under microscope. RESULTS: Tumors were completed resected in 11 cases, subtotally removed in 2 cases. Eleven patients had obtained anatomic preservation of the facial nerves. Complete follow-up information was obtained in all patients for a period of 3-15 months after operation. House-Brackmann Score in 8 case were Grade I-II, 4 cases Grade III-IV, one case Grade V. Grades I and II facial nerve function were maintained in 61.5% of cases, measurable hearing was preserved in 53.8% of cases(7 cases), and 38.5% of cases maintained serviceable hearing. No severe permanent operative complications were found and no surgical mortality occurred. CONCLUSIONS: Microsurgery with keyhole craniotomy is a safe and effective method for treatment of patients with small and medium-size acoustic neuromas. The advantages of keyhole suboccipital craniotomy are anatomical replacement, less postoperative complications, and beneficial to patient's mental health.

Adult↗

PubMed2002

[Importance of voice quality evaluation in the assessment of treatment outcome after endolaryngeal microsurgery].

The aim of the study was to compare subjective and quantitative voice characteristics changes after endolaryngeal microsurgery with respect to different postoperative follow-up term. We evaluated 80 surgically-treated patients aged 14-81 years (mean 42.6+/-13.8 years) with benign vocal cord (VC) lesions (polyps, n=37; cysts, n=16; Reinke's edema, n=18; papilomata, n=9). Patients were evaluated three times - before operation, less than two weeks (mean 1.0+/-0.4) following the operation and more than two weeks (mean 6.5+/-3.9) following the operation. Control group consisted of 122 healthy voice patients. Subjective voice evaluation composed of experts assessment (GRBAS hoarseness scale, visual analogue scale (VAS) of voice quality) and patients self-evaluation (VAS, voice handicap index, and the impression of what repercussions the voice problem has on professional life and emotions). Seven quantitative voice parameters obtained from voice range profile, laryngostroboscopy and registering of maximum phonation time were analyzed as well as overall vocal dysfunction degree (VDD). The data of second postoperative examination were statistically significantly better compared to the first postoperative follow-up (p<0.001). During the first postoperative examination the subjectively healthy voice (G=0) was found for 13.8% (11), quantitatively (VDD=0) for 22.5% (18) of patients, during the second - 63.8% (51) and 53.8% (43). The best results were for patients with vocal cords polyps. The complex voice assessment may be useful for evaluation of voice function recovery and efficacy of surgical treatment.

Adolescent↗

PubMed2000

[The clinical observation of microsurgery treatment in early glottic carcinomas].

OBJECTIVE: To improve the life quality of the patients with T1 glottic carcinomas, and obtain good vocal effect. METHODS: Twenty-two patients under shoring laryngoscope and microscope were operated by surgery and laser. The phonetic parameters and vocal cord states of preoperative and postoperative patients were evaluated and analyzed objectively. RESULTS: The three-year relapse rate was 9.0% (2/22), and the survival rate of three-year, four-year, five-year were 100%, 94.7%, 93.3% respectively. The postoperative phonetic quality was improved. CONCLUSION: Patients with early glottis carcinomas could be treated by microsurgery. The damage of normal tissue might be reduced, and the patient's life quality has been improved. This method should be used widely in clinic.

Adult↗