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At least 127 records · Page 7Linked to original sources

PubMed1999

[Microsurgery, a 'small' surgical revolution in the medical history of the 20th century].

Microsurgery in the twentieth century enabled surgeons to operate on very fine structures, which was impossible before the advent of the microscope. Since 1860 loupe magnification was employed in rare cases. In 1921 Nylén from Sweden transformed an ordinary laboratory microscope into an operation microscope for ear interventions. The eye specialists were the second group of doctors who employed the microscope in the operating theatre during the years 40-50 of this century. Since 1953 Zeiss in Germany has produced highly professional operation microscopes. In the sixties experimental laboratory studies were taken up to develop microsurgical techniques, microinstruments and suture material. Both plastic and reconstructive surgeons and neurosurgeons continued to develop microsurgery and indeed transformed their disciplines a great deal. Microsurgery is here to stay and still experiments are going on with video-assisted systems in order to further miniaturize the instruments for magnification and to gain a more comfortable working position for the surgeon.

History, 20th Century↗

PubMed1998

The influence of impaired microvasculature on regional blood flow of the spinal cord after microsurgery.

OBJECTIVE: To further investigate the impact of impaired microvasculature of spinal cord and its physiological compensation on postoperative morbidity after intramedullary microsurgery. METHODS: In 120 cats, the segmental anterior longitudinal spinal arteries (ALSA), the posterior longitudinal spinal arteries (PLSA), and the unilateral radiculomedullary arteries (RMA) were selectively coagulated in different patterns. Hydrogen electrode technique was used to detect the changes of regional blood flow of the spinal cord at different segments. Benzidine dihydrochloride (BDHC) staining was used to observe the microvascular pattern of the spinal cord, tetrazolium chloride (TTC) staining was applied to morphometric analysis of the ischemic area, and hematoxylin-eosin staining was applied to histologic examination. RESULTS: When the segmental ALSA was injured, the blood flow of the gray matter and white matter decreased greatly. Since the central arteries were the terminal blood supply arteries, no compensation occurred after the injury. The blood flow of the segment below the impaired segment hardly changed, indicating that the direction of the blood flow in ALSA altered to adapt the changes of the microvasculature. Injury to the unilateral PLSA and RMA at both cervical and lumbar area only caused a minor decrease in the regional blood flow, unless the perimedullary arterial system was considerably injured. In the thoracic medullary segment, the sparse microvasculature was the main cause for the segment vulnerable to ischemia and infarction. This was caused by not only the rarity of RMA as an anatomic factor, but also the small number and low activity of the neurons at this area. After microsurgery, the impairment and decompensation of the microvasculature were closely related to the ischemic volume of and pathological changes in the spinal cord. CONCLUSION: The impairment and decompensation of microvasculature after microsurgery are the rudimentary causes of spinal cord ischemia. During operation, one should protect the terminal arteries to decrease the severity of injury to the perimedullary system, and do the best to avoid disturbance of microvasculature to accelerate the recovery of postoperative ischemia and neurological dysfunction of the spinal cord.

Adaptation, Physiological↗

PubMedDate not supplied

Prospective study of the functional results of transanal endoscopic microsurgery.

BACKGROUND/AIMS: Most clinical research addresses the technological advances and oncological outcomes of transanal endoscopic microsurgery. Our aim was to examine the functional results. METHODOLOGY: From August 1999 to November 2000, 22 Taiwanese patients (14 men, 8 women; median age, 68 years) undergoing transanal endoscopic microsurgery were prospectively examined. Functional questionnaires and anorectal manometry were assessed before surgery and at 2 weeks, 6 weeks, 3 months, and 1 year. RESULTS: The median distance from the anal verge to the tumor was 10 cm. The median tumor diameter was 2.0 cm. The median duration of surgery was 120 minutes. No surgical mortality or morbidity and no local recurrence occurred during a median follow-up of 23 months. The mean stool frequency and consistency were significantly better at 3 months after surgery than before surgery. The maximal resting pressure significantly decreased after surgery. The maximal contraction pressure and maximal tolerated volume were significantly lower at 2 and 6 weeks than before surgery; these values recovered at 1 year. CONCLUSIONS: Transanal endoscopic microsurgery is safe for the cure of benign tumors and the palliative excision of malignant tumors in middle and upper rectum. Anorectal function was preserved and improved, though some anorectal manometric parameters changed over time.

Adenocarcinoma↗

PubMedDate not supplied

An evaluation of transanal endoscopic microsurgery for rectal adenoma and carcinoma.

BACKGROUND: Transanal endoscopic microsurgery was introduced in the early 1980s. Since then, increasing numbers of rectal adenomas are being excised by this technique. The aim of this study was to evaluate our institution's experience with transanal endoscopic microsurgery for rectal adenoma and carcinoma. METHODS: Seventy-five patients (adenomas, n = 58) underwent more than 90 TEM resections over a period of 5 years. RESULTS: Postoperative complications were minimal with 3% (n = 2) in the adenoma group requiring transfusion and 0% 30-day mortality. One patient in each group developed transient fecal incontinence. During the follow-up period, 6 patients (10%) in the adenoma group underwent further local resections for their recurrences. Two patients in the carcinoma group (1 each of pathological T1 and T2 stage) developed recurrence at 24 months. A female with a T2 tumor was found to have an inoperable lesion and underwent sigmoid colostomy. Five of 17 patients had postoperative radiotherapy, and 2 patients developed radiation enteritis. Four patients died during follow-up due to unrelated reasons. CONCLUSION: The transanal endoscopic microsurgery technique appears to be safe and associated with minimal morbidity. Careful selection of patients with thorough preoperative assessment is necessary for carcinoma patients. Patients with T1 lesions and favorable histology should only be considered for curative resection by this technique.

Adenoma↗

PubMed2004

Treatment of early rectal tumours by transanal endoscopic microsurgery in Hong Kong: prospective study.

OBJECTIVE: To summarise the results of transanal endoscopic microsurgery for the treatment of rectal villous adenoma and early rectal tumours. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Consecutive patients between November 1995 and January 2003. INTERVENTION: Transanal endoscopic microsurgery. MAIN OUTCOME MEASURES: Intra-operative morbidity and mortality, complication rate, operating time, postoperative morbidity and mortality, recurrence rate and correlation between preoperative ultrasonography staging and postoperative pathological staging. RESULTS: Thirty-two patients with rectal villous adenoma and early rectal carcinoma were registered, 31 of whom (14 men and 17 women) were included in the study. The median tumour size was 2.5 (range, 1-8) cm and the median operating time was 95 (45-220) minutes. The median follow-up period was 23 (2-92) months, and there was no local recurrence. There was no operation-related mortality and the resection margins were all clear. Complications included temporary flatus incontinence (n=2), acute retention of urine (n=1), exacerbation of chronic obstructive airway disease (n=1), and secondary haemorrhage in a patient on aspirin. CONCLUSIONS: Transanal endoscopic microsurgery is a safe procedure and can achieve good local tumour control. It is ideal in the management of rectal villous adenomas at stages pT0 and pTis. Its application is now extended to the treatment of early rectal carcinoma at stage pT1 with curative intent. For tumours at stage pT2 or later, it can also serve as a good option for local palliation.

Adenoma, Villous↗

PubMed2005

[Treatment of rectal tumors with transanal endoscopic microsurgery].

OBJECTIVE: The aim of this study was to assess one and a half years experience gained in Lithuania while treating rectal tumors with transanal endoscopic microsurgery in the Centre of Abdominal Surgery of Vilnius University Hospital "Santariskiu klinikos". MATERIALS AND METHODS: The patients who had rectal adenomas and low-risk T1 carcinomas of good or moderate differentiation, with no lymphatic and vascular invasion were selected for surgery. Tumor stage was determined by transanal endosonoscopy and rectoscopy with multiple macrobiopsies before surgery. RESULTS: A total of 47 patients were operated on. The average tumor size was 3.4+/-1.4 cm (ranged from 1 to 7 cm). Overall 25 (52.1%) carcinomas and 23 (47.9%) adenomas were removed. Pre-operative diagnoses did not correspond to the final clinical diagnoses in 14 (29.8%) cases. Forty-three (89.6%) radical operations (R0) and 5 (10.6%) doubtful complete operations (RX) were performed. One (2.1%) intra-operative complication and one (2.1%) post-operative complication were observed. After the removal of Ca T2 three patients underwent adjuvant radiotherapy. Twenty-six patients were followed up for 3-17 months after operation: 17 after removal of cancer and 9 after removal of adenoma. One (2.1%) recurrence of a tubulovillous adenoma was diagnosed. No other complications were reported. CONCLUSIONS: Initial results of transanal endoscopic microsurgery obtained while treating rectal adenomas and low-risk T1 cancers are promising. The low rate of complications and recurrences in this group offers many hopes. The experience of the treatment of T2 cancers with transanal endoscopic microsurgery and adjuvant radiotherapy is limited but the results are encouraging. It is obvious that the results of randomized and controlled trials need to be awaited before definite conclusions can be drawn.

Adenoma↗

PubMed2005

[Long-term results of treatment in T1, T2 laryngeal cancer with CO2 laser microsurgery].

The aim of this study was estimation the long term results of CO2 laser therapy in laryngeal cancer. 36 patients with early glottic cancer-T1 and T2 were treated with CO2 laser microsurgery in 1990-1992. The control laryngological, phoniatric and laryngovideostroboscopic examinations were conducted from six to thirty months after the operation. The next controls were done within three years and then after eight to ten years from microsurgery. The local recurrence was observed only during the first control in seven cases--19%. Four patients underwent total laryngectomy after several laser microsurgery, two were treated only with CO2 laser and one had CO-therapy. The better quality of voice was observed during following control examinations. A scar with smooth surface and marge in 29 persons and a tendency to phonatory vibration of scar in 9 patients were noticed in laryngovideostroboscopy examination during the first control. Following examinations showed a progressive improvement of voice parameters.

Carbon Dioxide↗

PubMed1992

Infertility surgery: microsurgery.

Tubal and peritoneal factors continue to be a leading cause of infertility. In vitro fertilization, operative laparoscopy, and microsurgery are alternatives, but they are frequently complimentary therapeutic approaches. Proper investigation is the key to select the primary treatment modality. A well-performed hysterosalpingography is most valuable in the initial assessment of the tubes and uterus. Hysterosalpingosonography, radionuclide hysterosalpingography, and falloposcopy are experimental investigative tools that may be useful in selected circumstances. Effective adjuvants to reduce postoperative adhesions continue to elude the surgeon and new substances are being experimented with. In proximal tubal obstruction, selective salpingography and tubal catheterization may differentiate cornual spasm from pathologic tubal occlusion and may be therapeutic when viscous material or endotubal synechia are the cause of obstruction. Microsurgery remains the effective approach for significant lesions such as salpingitis isthmica nodosa, endometriosis, obliterative fibrosis, and chronic follicular salpingitis. Distal tubal occlusion is amenable to treatment via either laparoscopy or microsurgery. The functional status of the oviduct appears to be the most important prognostic factor in subsequent pregnancy outcome.

Fallopian Tube Diseases↗

PubMed2006

Microsurgery within reconstructive surgery of extremities.

Reconstructive surgery of extremities is an object of a special attention of surgeons. Vessel and nerve damages, deficiency of soft tissue, bone, associated with infection results in a complete loss of extremity function, it also raises a question of amputation. The goal of the study was to improve the role of microsurgery in reconstructive surgery of limbs. We operated on 294 patients with various diseases and damages of extremities: pathology of nerves, vessels, tissue loss. An original method of treatment of large simultaneous functional defects of limbs has been used. Good functional and aesthetic results were obtained. Results of reconstructive operations on extremities might be improved by using of microsurgery methods. Microsurgery is deemed as a method of choice for extremities' reconstructive surgery as far as outcomes achieved through application of microsurgical technique significantly surpass the outcomes obtained through the use of routine surgical methods.

Extremities↗

PubMedDate not supplied

A comparison of microsurgery and laser surgery for ovarian wedge resections.

To evaluate the effect of microsurgery and CO2 laser on postoperative adhesion formation after ovarian wedge resection, 30 New Zealand adult female rabbits were randomly divided into three groups of ten animals each. The control group (n = 10) had ovarian wedge resections using a scalpel with closure of the ovary performed using microsurgery technique. The second group had ovarian wedge resections performed using the CO2 laser coupled to an operating microscope. The third group (n = 10) had multiple small areas of vaporization performed on the ovary using the CO2 laser. Four weeks after the initial surgery the animals were killed and evaluated for intraperitoneal adhesions. No significant differences (P greater than .05) were found between the three groups of animals. This study suggests that the use of laser surgery may not offer a significant reduction in postoperative adhesion formation in comparison with standard microsurgery technique when performing ovarian wedge resections.

Animals↗

PubMed1989

[Use of hemodilution in microsurgery].

From Nov. 1985 to Jun. 1988, we used the hemodilution in microsurgery. Of the 24 free flaps 22 survived and 2 failed. While the 17 free flaps in the patients without hemodilution, only 14 flaps survived. We think that the advantages of hemodilution applied to microsurgery are: 1. The common advantages in the field of surgery are to reduce amount of bleeding during the operation, to improve the blood perfusion to important organs, to avoid adverse blood reactions and to decrease the infectious diseases caused by the blood transfusion. 2. The outstanding advantages in microsurgery are as follows: (1) After moderate hemodilution had been performed, blood stickiness was so reduced that the resistance of blood stream was decreased. Because blood coagulation was reduced, bleeding and clotting time prolonged. The above-mentioned changes are beneficial to keep blood vessels unobstructed and also to prevent the free flaps from undergoing the crisis. (2) After moderate hemodilution has been performed, the speed of blood stream and the cardiac output were both increased, which made the free flaps be in a state of "overperfusion". The over-perfusion may both supply the free flaps with enough oxygen and eliminate metabolic products quickly, which will be beneficial for recovering of the flap shock and prevent the free flaps from occurring DIC.

Adolescent↗

PubMed1989

[Direct laryngoscopy and laryngeal microsurgery in children under general anesthesia].

The great local irritability, especially on mechanical agents (giving shock), required the great caution during the laryngeal microsurgery. Local anesthesia lowered the shock risk and assure the safe and precise maneuvers. However, the tracheal tube in the small children larynx limits the visibility. The aim of this work is the description of our experiences in direct laryngoscopy and laryngeal microsurgery in children under general anesthesia, by use of tracheal tube. The significant modification is a metal tube, fixed to the laryngoscope, by which the halothane and oxygen mixture was given constantly. 201 endoscopy and microsurgery maneuvers of the larynx were performed in our Clinic.

Anesthesia, General↗

PubMed1989

Evolution and present status of orthopedic microsurgery in Greece.

Replantation of complete or incomplete nonviable amputations of digits, hands, and major limbs along with a number of reconstructive microsurgical procedures reflect the work that has been done in the field of orthopedic microsurgery in Greece during the last ten years. The history of trauma microsurgery in Greece starts in the mid-1970s, when the first attempts were directed toward patients with complete or incomplete nonviable amputations of digits and hands. Few cases of major limb replantations without the aid of an operating microscope or other means of magnification have been reported for the years 1965-1975. The first successful digital replantation was performed in 1979 on a female patient with multiple digit amputations; only the little finger was successfully replanted. More than 310 replantations and revascularization procedures have been performed during the past decade, mainly in two major replantation centers, with an overall success rate of 85% for complete and 90% for incomplete nonviable amputations. Reconstructive microsurgical procedures are mainly related to free skin flaps, vascularized bone grafts, toe-to-thumb transfer, and peripheral nerve microsurgery.

Greece↗

PubMedDate not supplied

Proximal tubal occlusion: microsurgery versus IVF--a review.

The success of IVF has established it as a viable alternative to microsurgery in the treatment of infertility associated with certain types of tubal occlusion. The authors have recently reported on the success rates of microsurgery versus IVF in cases of distal tubal occlusion. The present study summarizes the results reported in the world literature for microsurgery in cases of proximal tubal occlusion secondary to surgical sterilization, previous infection, or endometriosis, and compares them with the results reported for IVF. Based on what has been published to date, it appears that microsurgical tubocornual anastomosis remains the procedure of choice for proximal tubal occlusion.

Constriction, Pathologic↗

PubMed1986

[Sterility of tubal origin: microsurgery and fertilization in vitro].

Thanks to recent advances, in-vitro fertilization should alter the clinical indications in cases of sterility due to tubar obstruction. In this article, the authors compare two groups of patients: one group of 109 women treated by means of in-vitro fertilization and another group of 117, treated by microsurgery. In tubar sterility, IVF achieved a 16% pregnancy rate per attempt. In the case of microsurgery, the actuarial rates were calculated (Kaplan Meier method) from a prognostic score. It was found that in the group of women with a "good score", tubar surgery gave results which could be achieved only after 3 or 4 attempts at IVF. On the other hand, in the "poor prognosis" group, IVF was better than microsurgery after a single attempt. Clinical teams should, therefore, reconsider the indications for tubar surgery in the light of the indications for in-vitro fertilization.

Embryo Transfer↗

PubMed1986

[Microsurgery of distal tubal lesions. Analysis of 270 operated cases].

Between 1978 and 1983, more than 600 microsurgical tubal operations were performed. Only 270 women with the same extent of distal tubal lesions on both sides or with unilateral tubal occlusion after heterolateral salpingectomy were considered in this study. The authors propose a classification of distal tubal lesions in order to analyze the results of microsurgery. After fimbrioplasty, salpingolysis and salpingostomy for distal occlusion without ampullary dilatation, the term pregnancies rate is more than 50%. The pregnancy rate after salpingostomy for hydrosalpinx is 25%. The prognosis after microsurgery for distal tubal lesions is related to ciliated cells percentage. The prognosis of microsurgical salpingostomy for thick-walled hydrosalpinx is poor. In these cases, in vitro fertilization should be the treatment of preference. In conclusion, the ampullary diameter and the fimbrial ciliated cells percentage are prognostic factors of distal tubal microsurgery.

Constriction, Pathologic↗

PubMed1979

[Surgical treatment of tubal sterility macrosurgery versus microsurgery? (author's transl)].

Results of surgical treatment of tubal sterility obtained via "microsurgery" are compared with those of "microscopic microsurgery", as far as it is possible at this stage. Preliminary resumé: Microscopic technique obviously produces better results in reanastomoses after sterilisation, whereas in the case of salpingostomies the results are similar to those obtained via "macroscopic microsurgery".

Fallopian Tube Diseases↗

PubMed1984

[Microsurgery of the fallopian tube].

9 per cent of all patients with female sterility are indicated to be operated on. After discussing the conditions for microsurgery the indications like salpingolysis, ovariolysis, fimbrioplasty, salpingoneostomia, anastomosis, conservative operations of ectopic pregnancy and endometriosis are argued in detail. Microsurgery improves pregnancy rates about 20 per cent. The principles of microsurgery should have a wider entrance in gynecologic operations.

Endometriosis↗