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At least 109 records · Page 6Linked to original sources

PubMed2000

Image-guided microsurgery with the Mehrkoordinaten Manipulator system for cerebral arteriovenous malformations.

Four patients with cerebral arteriovenous malformations (AVMs) underwent image-guided microsurgery with the Mehrkoordinaten Manipulator (MKM) system, which integrates a robotic microscope with a computer workstation. The patients were all male, from 8 to 51 years old (mean = 24), all presenting with intracerebral haemorrhage. The lesion was located in the deep sylvian fissure in one patient, the fronto-parieto-occipital area in one and the trigone in two. Stereotactic computed tomography and magnetic resource imaging of 1-mm slices were taken. The extent of AVM and the draining vein, predetermined with the MKM workstation, could be superimposed on the microscopic view, resulting in minimum scalp incision and craniotomy, as well as allowing for a stereotactic approach to deep-seated lesions. Superimposition of the contour of the lesion was also useful for resecting the lesion, although intraoperative diagnosis of the total resection required intraoperative digital subtraction angiography. In conclusion, image-guided microsurgery with the MKM system can assist minimally invasive and maximally effective microsurgery for cerebral AVMs.

Adolescent↗

PubMed2000

Robotic assistance in microsurgery.

The purpose of this study was to introduce a new robotic system for microsurgical procedures of the eye, ear, brain, face, and hand. The design and main features of the Robot Assisted MicroSurgery (RAMS) work station are described. In addition, compatibility with the operating-room table is assessed. The engineering components of the RAMS work station consist of a laptop computer, a joystick, a mouse, slave robot, VME and amplifier chassis, and safety control box. The mechanical part of the RAMS, the slave robot, is designed to simulate movements of the human upper extremity, which has five joints and six degrees of motion. The robot has a zero backlash in five joints, and can sustain full extension of loads over three pounds. The arm measures 2.5 cm in diameter, and it is 34.6 cm long from its base to its tip. The arm and its base weigh 2.5 kg. Motors and encoders on the robot are easily removable, allowing for the arm to be sterilized in an autoclave. Assessment of robotic positioning, time for setup, relative precision, and possible problems in the operating field are compared with human-assisted microsurgical procedures. Robotic arm positioning on the operating-room table differs for each type of procedure. For those involving the hand and upper extremity, the robotic arm base occupies 35 percent of the operating table; this is only 10 to 15 percent for human-assisted procedures. The setup time for robot-assisted procedures is longer than for human-assisted surgery. However, microsurgical manipulations with the RAMS are more rapid than the surgeon's motions. Therefore, depending on the type of procedure, the total operating time is comparable to human-assisted procedures. The movement of the RAMS was found to be more precise, in attempting to perform vascular and neural anastomoses. The authors conclude that concurrent use of the remote-controlled RAMS as a microsurgical assistant is applicable in microsurgery, with the advantages of greater precision and more rapid microsurgical manipulation. However, the long-term cost effectiveness of using this system as an assistant in microsurgery warrants further investigation.

Anastomosis, Surgical↗

PubMed2001

Role of medical students in microsurgery research.

Microsurgery is an integral element in many surgical specialties, as well as an important technique for surgical research. Student participation in microsurgery research programs can be a source for both high quality training in skills and for research contributions. In this article, the authors review their experience in developing general principles for setting up medical student microsurgery research programs, and analyze the research output and career choices made by the students who have participated.

Adult↗

PubMed1998

Acute pulmonary edema after microsurgery: two case reports.

Postoperative management procedures after microsurgery are well-established. Usually, maintaining an adequate plasma volume will lower blood viscosity and will provide an adequate arterial inflow to keep the replantation or the flap viable in routine microsurgical procedures. But if the patient's underlying condition is neglected, disasterous complications may occur. The authors report two cases with severe postoperative complications after microsurgery. One patient was a 38-year-old male who suffered from diabetic foot ulcer and received a free muscle flap transfer. He developed acute pulmonary edema at day 6 postoperatively. The other patient was a 20-year-old pregnant woman at 31 weeks gestation who developed pulmonary edema on the POD 4 following microsurgical replantation of the thumb and index finger of her left hand. The complications were believed to be caused by fluid overload and neglect of the patients' underlying conditions. Knowledge of possible precipitating factors and careful monitoring of fluid should avoid acute pulmonary edema after microsurgery under certain unusual conditions.

Adult↗

PubMed1991

Reproductive outcome after ovarian surgery: microsurgery versus CO 2 laser.

The present study was undertaken to compare CO 2 laser vs microsurgery in ovarian surgery, evaluating both postoperative adhesion formation and reproductive outcome. Eighteen female white New Zealand rabbits were anesthetized, and the ovaries were exposed. At random, one ovary was longitudinally bivalved with a scalpel and then reconstructed by microsurgery. The contralateral ovary was similarly cut, but with a CO 2 laser set at a superpulsed mode. Four weeks after surgery, the rabbits were mated, and two weeks later, the animals were evaluated for extent of postoperative adhesion formation, number of corpora lutea in each ovary, and number of embryos in each uterine horn. The nidation index was calculated. The present study shows no difference in postoperative adhesion formation or reproductive function following ovarian surgery by microsurgery or CO 2 laser.

Animals↗

PubMed2005

Computer-assisted, robot-enhanced open microsurgery in an animal model.

BACKGROUND: Computer-assisted, robot-enhanced surgery improves laparoscopic and thoracoscopic surgery through tremor filtration, motion scaling, articulation, and improved ergonomics. Surgeons perform many open cases under magnification that magnifies the tremor present in all surgeons' hands, so the tremor filtration and motion scaling of robotic surgery may improve microsurgery. Our goal was to compare microvascular anastomoses performed with a robot-enhanced technique with a standard technique. METHODS: We performed end-to-end anastomoses in 1-mm rat femoral arteries with interrupted 10-0 suture. We compared the anastomotic time, patency, and leak rates between traditional microsurgery techniques (by hand) and a robot-enhanced technique using the Zeus robotic surgery system (Computer Motion, Goleta, California). The surgeon used an operative microscope for visualization in both techniques. RESULTS: We performed 30 anastomoses by hand and 31 with Zeus. We observed a remarkable degree of tremor filtration in the robot-enhanced cases. Anastomotic times for both techniques demonstrated a learning curve. Anastomoses done by hand (mean time, 17.2 minutes) were significantly faster than those done with Zeus (mean time, 27.6 minutes) (P = 0.0006). All anastomoses from both groups were patent, and none leaked after 3 minutes. CONCLUSION: The Zeus system is effective at performing complex, open, microsurgery tasks in vivo. There was no measurable benefit from the remarkable tremor filtration and motion scaling offered by robot-enhanced surgery.

Anastomosis, Surgical↗

PubMed2006

Curative resection of rectal carcinoid tumors with transanal endoscopic microsurgery.

BACKGROUND: Transanal endoscopic microsurgery is a minimally invasive technique for local resection of rectal tumors. Its place needs to be defined for resection of carcinoid tumors of the rectum. MATERIALS AND METHODS: From 1998 to 2004, rectal carcinoid tumors were diagnosed in 5 patients. The diagnosis was suggested at biopsy in all patients. All tumors were resected full thickness with transanal endoscopic microsurgery. Data were obtained retrospectively from a review of hospital charts. RESULTS: At the time of operation all tumors were small without clinical or biochemical signs of metastasis. All resected tumors were highly differentiated and had free margins without invasion into the submucosa. Operative times ranged from 15 to 35 minutes. Hospital stays ranged from 2 to 4 days. No morbidity or mortality was observed. Follow-up ranged from 3 to 75 months. No recurrences were observed. CONCLUSION: Transanal endoscopic microsurgery is an excellent technique for removal of carcinoid tumors of the rectum and even the distal part of the sigmoid, if the diameter is <1 cm without invasion of the rectal wall.

Adult↗

PubMed2002

Proliferation potential in recurrent acoustic schwannoma following gamma knife radiosurgery versus microsurgery.

OBJECTIVE: To evaluate the proliferation potential of recurrent acoustic schwannoma following gamma knife radiosurgery (GKR) versus microsurgery. STUDY DESIGN: Retrospective study. METHODS: A review of surgical records of the House Ear Clinic revealed 8 patients who had undergone GKR and 15 patients who had undergone microsurgery who had unilateral acoustic schwannoma recurrences. Immunohistochemical studies were performed to evaluate the expression of proliferating cell nuclear antigen (PCNA) on archival paraffin-embedded blocks. RESULTS: All 8 GKR and 15 microsurgical tumors had positive staining for PCNA. The recurrent GKR tumors had significantly lower proliferation levels than in the microsurgical group (P = .03). Two GKR tumors had high proliferation levels. CONCLUSIONS: Our study indicates that recurrent vestibular schwannomas treated with GKR have lower proliferation potential as assessed by PCNA compared with recurrences following microsurgery. Radiation-induced apoptosis is thought to contribute to the lower tumor cell proliferation in GKR tumor. The two GKR tumors with high proliferation potential could be a result of radiation-induced sporadic mutation, resulting in high tumor cell proliferation.

Apoptosis↗

PubMed2004

Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill.

PURPOSE: We evaluated the durability of laboratory based technical skills training in urological microsurgery using bench model simulators. METHODS AND MATERIALS: A total of 50 junior surgery residents (post-graduate years 1 to 3) were recruited to participate in a focused training program in urological microsurgery. Prior to training subjects were randomized to receive hands-on training with bench model simulators (silicone tubing or live rat vas deferens, 40) or didactic training alone (10). Four months following the original training program the technical performance of 18 returning subjects (13 from the bench model and 5 from the didactic training group) was reevaluated using a high fidelity, live animal model (vasovasostomy and rat vas deferens). Outcome measures included blinded, expert assessment of videotaped performance using checklists and global rating scores, and evaluation of anastomotic patency. RESULTS: The retention test checklist (p <0.001), global rating scores (p <0.001) and anastomotic patency rates (p = 0.05) in the live animal model remained significantly higher for subjects who originally received hands-on bench model training compared with those who received didactic training alone. The number of interim practice opportunities with microsurgery correlated significantly with expert global ratings of surgical performance irrespective of the nature of training (r = 0.54, p = 0.02). CONCLUSIONS: Laboratory based technical skills training with bench models can lead to a significant retention of technical skill by novice surgeons. Measured performance improvements appear to be durable with time. However, the opportunity for repeat hands-on practice appears to maximize the retention of technical skill.

Adult↗

PubMed2004

Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma.

The best way to manage small and medium-sized vestibular schwannomas is currently a matter of heated debate. As these tumours are not immediately life-threatening, patients are invariably concerned about how management would affect their quality of life. Until now, no study has compared the three treatment modalities in terms of physical, psychological and social wellbeing. This study is based on a retrospective database analysis and postal questionnaire survey of unilateral vestibular schwannoma patients who had either been managed conservatively, or treated with microsurgery or radiosurgery. The results showed that: quality of life (measured by the Glasgow Benefit Inventory) deteriorated after microsurgery, particularly for small tumours; conservative management did not lead to a change in quality of life, and there was a trend towards poorer quality of life following radiosurgery. The findings suggest that a conservative management approach may be more appropriate for small tumours, and that patients who are due to undergo microsurgery or radiosurgery may benefit from counselling about the potential impact of treatment on quality of life.

Adult↗

PubMed2003

Periodontal microsurgery.

UNLABELLED: The purpose of this article is to introduce the history of microsurgery in the surgical disciplines. It reviews the benefits and potential applications of magnification and microsurgery in the specialty of periodontics. Esthetic procedures encompassing periodontal plastic microsurgery are described with an emphasis on clinical cases to demonstrate their application. CLINICAL SIGNIFICANCE: The use of magnification, in particular the use of surgical operating microscopes, has increased in many areas of dentistry. This article demonstrates the usefulness of microscope-enhanced periodontal surgery and addresses many issues involved in its application to the surgical discipline of periodontics.

Alveolar Ridge Augmentation↗

PubMed1987

Tubal microsurgery. I. The principles.

Microsurgery has become an accepted method in the treatment of tubal infertility. But microsurgery implies more than the use of magnification alone. The 'microsurgical principles', the adjuvantia and the possible causes for failures of microsurgery are reviewed.

Fallopian Tube Diseases↗

PubMedDate not supplied

Endotracheal intubation and Venturi (jet) ventilation for laser microsurgery of the larynx.

Meeting the exacting requirements for microsurgery of the larynx is a challenge for the anesthesiologist. To accomplish, the necessary dissection, the otolaryngologist has several requirements. They are a quiet relaxed field, excellent illumination with magnification, binocular vision for depth perception, and, above all, an unobstructed field. The management of anesthesia for suspension microsurgery on the larynx presents many problems, the most vexing of which is the fact that the otolaryngologist and anesthesiologist are in competition for access to the patient's airway. In sharing this, neither has been able to perform with the degree of control that he would like due to either inadequate operating conditions or insufficient access to ventilatory mechanisms. Several anesthetic techniques have been used for inspection or operative laryngoscopy: topical anesthesia, apneic techniques, translaryngeal topical anesthesia, chest respirator, neuroleptanalgesia, and general endotracheal anesthesia with muscle relaxants. The latter has proven most popular, particularly in children, because ventilation and surgical conditions are considered to be most controllable. However, the presence of the requisite endotracheal tube obscures the full view of the larynx and vocal cords, and the tube may itself become obstructed. Additionally, use of the laser involves the further risk of heat effects on the endotracheal tube if the beam hits the tube. This report presents our experience and development of the combined technique of endotracheal intubation and Venturi (jet) ventilation. We believe it represents the safest available approach while providing near ideal working conditions for the otolaryngologist during laser microsurgery of the larynx.

Adolescent↗

PubMed1998

Carbon dioxide laser microsurgery for early supraglottic carcinoma.

Forty-eight untreated patients with early supraglottic carcinoma (12 patients stage I and 36 patients stage II) had primary carbon dioxide laser microsurgery between 1979 and 1994 with the intent of complete tumor removal with preservation of functionally important structures of the larynx. Ninety-six percent of the patients were treated exclusively by surgery; 4% had laser microsurgery and postoperative radiotherapy. With a median follow-up of 55 months, the 5-year local control rate with the first treatment was 100% for pT1 cases and 89% for pT2 cases. The ultimate local control rate with voice preservation, including patients successfully salvaged after a local recurrence, was 97% for pT2 carcinomas. Five (10%) patients died of tumor (TNM)-related deaths. The 3-year recurrence-free rate and 3-year overall survival rate (Kaplan-Meier) were 87% and 85%; the 5-year recurrence-free rate and 5-year overall survival rate were 83% and 76%, respectively. The results achieved with transoral laser microsurgery in early supraglottic carcinoma are comparable to those of open supraglottic laryngectomy with respect to local control and survival. The functional results are superior, since clinically relevant aspiration did not occur.

Adult↗

PubMed1996

Previous ectopic pregnancy should be considered a contraindication for microsurgery.

BACKGROUND: To estimate the risk of subsequent ectopic pregnancy (EP) after tubal surgery, given that the woman becomes pregnant, by means of a logistic model, a retrospective study was initiated. METHODS: During the period 1986-1990, 221 women with tubal infertility underwent microsurgery. Subsequent fertility was evaluated in 1991. Ninety women conceived, of whom 84 were included in the study (30 with EP and 54 with intra-uterine pregnancy as the only outcome). Clinical background factors of importance, surgical procedures used, scoring systems for tubal lesions, adnexal adhesions and risk of EP were analysed for possible correlation to subsequent EP. These factors were further used in a logistic model to estimate the risk of subsequent EP as only outcome. RESULTS: The risk of EP after microsurgery is minimum 15% without any risk factors. Previous EP and endometriosis could be identified as factors with prognostic power in the logistic model. One previous EP implies a 60% risk, whereas two previous EPs and endometriosis increase the risk to 95%. CONCLUSION: Patients with previous EP should generally not be considered for microsurgery owing to the high risk of recurrence and to the reduced chance of intra-uterine pregnancy.

Adult↗

PubMed1997

Role of transanal endoscopic microsurgery in the palliative treatment of rectal cancer.

BACKGROUND: Palliative, minimal invasive treatment of rectal cancer is advocated in patients with advanced and incurable disease or poor clinical condition and in those who refuse radical surgery. Several methods have been used during recent years. We report our experience with palliative transanal endoscopic microsurgery. MATERIALS: Between 1983 and 1995, 29 patients underwent transanal endoscopic microsurgery for palliation. Eleven patients had advanced malignant disease, nine were in poor clinical condition, and nine repeatedly refused radical surgery. RESULTS: Intraoperatively one severe complication, an intra-abdominal perforation, occurred. The morbidity rate was 14%. Postoperatively, clinical signs were abolished or improved in all cases. Only three patients required further palliative resections after initial symptom relief. CONCLUSIONS: Transanal endoscopic microsurgery is a successful approach in the palliative treatment of rectal cancer. The technique enables complete resection of rectal tumors. Although anesthesia is needed, the morbidity is low, even in patients with poor clinical condition.

Abdominal Pain↗

PubMed1986

Reconstructive microsurgery--a review.

We present some important current applications of reconstructive microsurgery. This field is expanding rapidly and the techniques are finding application in many branches of surgery. There is a pressing need for educational programs and training in microsurgery, as well as for continued research. Many of the procedures reviewed here have already been shown to substantially reduce costs, shorten hospitalization, and lessen patient disability; and as a result, several conventional procedures have been out-dated. We have stressed the concept that this is team surgery. To cover the needs of replantation and emergency free flaps around the clock, several microsurgeons must work together in established centers, and the team must possess expertise from all the involved surgical specialities. This may imply revision of many organizational aspects of patient care. Replantation centers would provide the necessary educational bases and give an impetus to the development of microsurgery.

Bone Transplantation↗

PubMed1998

Vestibular schwannoma management. Part II. Failed radiosurgery and the role of delayed microsurgery.

OBJECT: The indications, operative findings, and outcomes of vestibular schwannoma microsurgery are controversial when it is performed after stereotactic radiosurgery. To address these issues, the authors reviewed the experience at two academic medical centers. METHODS: During a 10-year interval, 452 patients with unilateral vestibular schwannomas underwent gamma knife radiosurgery. Thirteen patients (2.9%) underwent delayed microsurgery at a median of 27 months (range 7-72 months) after they had undergone radiosurgery. Six of the 13 patients had undergone one or more microsurgical procedures before they underwent radiosurgery. The indications for surgery were tumor enlargement with stable symptoms in five patients, tumor enlargement with new or increased symptoms in five patients, and increased symptoms without evidence of tumor growth in three patients. Gross-total resection was achieved in seven patients and near-gross-total resection in four patients. The surgery was described as more difficult than that typically performed for schwannoma in eight patients, no different in four patients, and easier in one patient. At the last follow-up evaluation, three patients had normal or near-normal facial function, three patients had moderate facial dysfunction, and seven had facial palsies. Three patients were incapable of caring for themselves, and one patient died of progression of a malignant triton tumor. CONCLUSIONS: Failed radiosurgery in cases of vestibular schwannoma was rare. No clear relationship was demonstrated between the use of radiosurgery and the subsequent ease or difficulty of delayed microsurgery. Because some patients have temporary enlargement of their tumor after radiosurgery, the need for surgical resection after radiosurgery should be reviewed with the neurosurgeon who performed the radiosurgery and should be delayed until sustained tumor growth is confirmed. A subtotal tumor resection should be considered for patients who require surgical resection of their tumor after vestibular schwannoma radiosurgery.

Aged↗