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 163 records · Page 9Linked to original sources

PubMed1975

Acromegaly. Treatment by transsphenoidal microsurgery.

Serum growth hormone levels, thyroid function, and adrenal function were measured before and after surgery in 16 of 17 acromegalic patients undergoing undergoing transnasal transsphenoidal microsurgery of the pituitary. Thirteen patients have been followed up for 12 to 24 months; three patients have been followed up for three to six months. Serum growth hormone levels decreased to less than 5 ng/ml in seven of nine previously untreated patients; thyroid and adrenal function were preserved in eight of these nine patients. In seven patients treated previously by other modes of therapy, growth hormone levels after transsphenoidal surgery decreased to less than 5 ng/ml in three, to between 5 and 10 ng/ml in three, and from 98 to 41 ng/ml in one. Preoperative adrenal function was normal in six of these seven patients and was preserved in four; thyroid function was normal in five patients preoperatively and was preserved in three. Transsphenoidal microsurgery appears to offer an effective means of lowering growth hormone levels and a possiblity of preserving any remaining normal pituitary function. It may be considered for initial treatment in selected patients in whom more rapid arrest of acromegaly is indicated.

Acromegaly↗

PubMed1998

Frontiers in lymphatic microsurgery.

The Authors report an overview on the modern surgical treatment of peripheral lymphoedema. The aim of lymphatic microsurgical operations is to drain the lymph either toward the venous circulation (lympho-venous shunts) or the lymphatic collectors above the obstacle to the lymph flow, with the interposition of lymphatic or venous grafts (lymphatic-venous-lymphatic plasty). Selection of candidate patients for lymphatic microsurgery is based on an adequate diagnostic investigation, which includes above all lymphoscintigraphy, conventional oil contrast lymphangiography, Doppler venous flowmetry and manometry, and, if necessary (angiodysplasias), an accurate study also of the artery circulation. The clinical outcome of lymphatic microsurgery, assessed by water volumetry and lymphangioscintigraphy, performed at variable distance of time from operations till over 5 years after surgery, shows a significant reduction of edema volume and improvement of lymph flow in all patients and that the more precocious the microsurgical treatment the better the results.

Anastomosis, Surgical↗

PubMed1998

Microsurgery and varicocele: state of the art.

Many surgical procedures have been proposed in the treatment of varicocele; however, the rate of recurrence and of postoperative complications, together with important correlation of this disease with male sterility, has played an important role in determining the success of microsurgery. In the present brief review, the indications for microsurgery and microsurgical dissection and/or anastomosis are described in comparison to traditional surgery.

Anastomosis, Surgical↗

PubMed2005

Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery.

BACKGROUND: Local excision after radiotherapy for node-negative low rectal cancer may be an alternative to radical excision. This study evaluated the results of local excision in patients with small (less than 3 cm in diameter) T2 and T3 distal rectal tumours following neoadjuvant therapy. METHODS: One hundred patients with rectal cancer (54 uT2 and 46 uT3 uN0 tumours) were enrolled. All patients underwent preoperative radiotherapy followed by local excision by means of transanal endoscopic microsurgery. RESULTS: Definitive histological examination revealed nine pT1, 54 pT2 and 19 pT3 tumours. A complete response (R0) or microscopic residual tumour (R1mic) was found in three and 15 patients respectively. Minor complications occurred in 11 patients and major complications in two. At a median follow-up of 55 (range 7-120) months, the local failure rate was 5 per cent and metastatic disease was found in two patients. The cancer-specific survival rate at 90 months' follow-up was 89 per cent, and the overall survival rate 72 per cent. Salvage abdominoperineal resection was performed in three patients, two of whom were disease free at 15 and 19 months. CONCLUSION: Treatment of small uT2 and uT3 uN0 rectal cancers with preoperative high-dose radiotherapy followed by transanal endoscopic microsurgery is an acceptable alternative to conventional radical resection.

Adult↗

PubMed2001

Activation of coagulation and fibrinolysis during reconstructive microsurgery in patients with cancer.

Cancer patients are subjected to increased systemic risk of thrombotic events and may therefore be at higher risk of even local thrombosis compromising the outcome of reconstructive microsurgery. Coagulation and fibrinolysis activities were studied serially during and after reconstructive microsurgery in seven patients with oropharyngeal cancer or sarcoma in the extremities. A preoperative hypercoagulable state was found in four patients (elevated fibrinogen, TAT, F1+2, or D-dimer); two of these patients also had a local thrombotic event. In all patients, the plasma markers generally varied perioperatively: fibrinogen decreased, whereas TAT and subsequently D-dimer increased at the end of the operation. However, tPA and PAI-1 remained unaltered, except in the patients with thrombosis in whom PAI-1 activity increased progressively during the operation. F1+2 was also clearly elevated in these two patients at the time of thrombosis. Preoperative assessment of hypercoagulability for this group of patients could be helpful in targeting meticulous antithrombotic protection.

Adult↗

PubMedDate not supplied

Microsurgery in otology and laryngology: a review of developments during the past thirty years.

The operating microscope was originally introduced to provide better visualization and illumination for otologic surgery. The successful use of this instrument in the fenestration operation for otosclerosis rapidly led to its application to reconstructive procedures in chronic suppurative otitis media. Later, it became evident that the operating microscope also provided advantages in the treatment of inner ear disorders and in the removal of acoustic Schwannomas; a considerable reduction in morbidity and an improved prognosis have resulted from application of microsurgery to these conditions. In addition, new photographic and television equipment, used in combination with microsurgery, has greatly improved the standards of teaching and the recording of pathologic information.

Humans↗

PubMedDate not supplied

New trends in carbon dioxide laser microsurgery.

The carbon dioxide laser has been used for cutting and cauterizing tissue in a variety of surgical procedures by means of a dry-field air/tissue interface approach. Recently, a new wet-field CO2 laser technique has been developed and is being used successfully in humans to seal intraocular fibrovascular fronds and retinal tears at the time of vitrectomy, to close rubeotic vessels in the iris, and to excise fibrovascular fronds and epiretinal membranes in cases of severe diabetic retinopathy. Specialized wet-field CO2 laser photosurgical probes for use in gynecologic microsurgery have been developed and are being studied experimentally. Other potential applications include otolaryngologic microsurgery, neurosurgery, and gastrointestinal and urologic wet-field surgery.

Carbon Dioxide↗

PubMed1993

History of microsurgery--from the beginning until the end of the 1970s.

Fine surgeries were started by vascular surgeons in the mid 1500s and included vascular ligature or suture of vascular wounds incurred in battle. Between 1800 and 1900, vascular end-to-end or end-to-side anastomoses and autogenous vein grafts became possible due to the efforts of Eck, Carrel and Guthrie. Thereafter, several experiments were performed for the transplantation of organs and limbs. Since the first use of the monocular microscope for ear surgery by Nylén in 1921 and the use of the binocular microscope by Holmgren in 1923, true microsurgery has developed and has gradually been specialized for every clinical discipline including otorhinolaryngology, ophthalmology, brain-neurosurgery, orthopedic surgery, plastic surgery, transplantation surgery, oncology, gynecology and urology. This could not have been accomplished without the development of the Zeiss operating microscope (OpMi system), fine microinstruments, and fine suture materials. The author describes the history of microsurgery from its beginning through the end of the 1970s, covering as many surgical disciplines as possible.

Animals↗

PubMed1994

Microcirculation research, angiogenesis, and microsurgery.

Angiogenesis, the formation of new blood vessels, is essential to a variety of normal and pathologic processes such as wound healing and tumor growth. In microsurgery the development of new vessels between the transferred tissue and the recipient bed is critical to the final outcome of the reconstruction. Several experimental models have been previously developed to study angiogenesis and the effect that new substances have on regulating this process, but they lack the ability to make quantitative measurements. Therefore, we have developed an animal model using the homozygous (hr/hr) hairless mouse ear; by using intravital microscopy and computer-assisted analysis, angiogenesis can be quantitatively measured. Using this model we showed that basic fibroblast growth factor and transforming growth factor beta significantly increased total vessel length by 32% and 63%, respectively, during 20 days following subcutaneous injection. In this paper the importance of angiogenesis research to reconstructive microsurgery is presented and discussed.

Animals↗

PubMed1994

Transpositional microsurgery in multiple digital amputations.

In 34 of the 62 patients treated for complete multiple digital amputations, the severed part was not replanted in its anatomical position, but in the place of the most useful stump. This procedure is defined as transpositional digital microsurgery and refers to the transposition and replantation of any digit to another stump which plays a more significant role in the function of the hand. Twenty-eight patients had transposition of a digit, while six patients underwent thumb transposition. All except six of the transposed digits survived, while all of the thumbs survived the surgical procedure. The cosmetic appearance of the hand with a transposed digit or thumb was acceptable to the patients. Two-point discrimination was assessed to be 10-14 mm for the transposed digits, and the functional ability of the transplanted digit was comparable to digits which were replanted in their anatomical position. In conclusion, transpositional digital microsurgery remains a useful alternative for the treatment of multiple digit amputations, particularly in patients with severely damaged non-replantable amputated parts.

Adult↗

PubMed2006

Review of microsurgery and arteriovenous fistulae for hemodialysis.

Patient comorbities, a patient's age and weight, the experience of the surgeon, and state of current vascular access are all factors used in determining the employment of microsurgical techniques to create or salvage an arteriovenous fistula (AVF) for hemodialysis. The aim of this study was to provide an overview of the literature concerning the use of microsurgery for AVFs as the permanent vascular access for both adults and children with end-stage renal disease (ESRD). The patient's overall state of health and long-term survival are always prime considerations in any medical management situation, and any technique that can make these goals more easily attainable by more patients is to be highly valued. Microsurgery for the establishment and repair of AVFs is another useful tool which is available if needed, depending on the unique needs of the patient, to aid the medical community in providing the best possible healthcare.

Adult↗

PubMed2006

Design and creation of an experimental program of advanced training in reconstructive microsurgery.

In this study, we design an experimental protocol for the purpose of enhancing performance in training in microsurgery. It is based on five free tissue transfer exercises in rat (epigastric cutaneous flap, saphenous fasciocutaneous flap, epigastric neurovascular flap, saphenous muscular flap, and hindlimb replantation), which simulate the principal clinical procedures of reconstructive microsurgery. The first part of the study consists of an anatomical review of the flaps of 5 rats and in the second part we have carried out the free transfer of flaps on 25 rats divided into 5 groups. To differentiate between them, we have created a mathematical function, referred to as difficulty in a microsurgical exercise, which has enabled us to establish a scale of progression for training, ranging form the easiest to the most difficult. As a conclusion, we believe that this protocol is a useful instrument as it allows for a more precise assessment of microsurgical capacity due to enhanced accuracy in the reproduction of global procedures and the fact that the quantification of progress in training is based on clinical monitoring after 7 days.

Animals↗

PubMed1993

Micromanipulation of chromosomes in PTK2 cells using laser microsurgery (optical scalpel) in combination with laser-induced optical force (optical tweezers).

An optical scalpel and optical tweezer have been combined to perform intracellular microsurgery and micromanipulation in vivo. When only laser microsurgery was performed on metaphase chromosomes, the dissected sister chromatid fragments drifted off to either the side of the spindle or completely off the spindle. At anaphase the fragments separated and the two arms generally moved to their respective daughter cells. When the chromosome arm was cut during anaphase A and B, the distal chromosome fragment separated from the rest of the chromosome and moved toward the pole, following the proximal chromosome fragment. Distal chromosome fragments laser-dissected during metaphase were held together throughout anaphase using the optical trap. Optical trapping of dissected chromosome fragments during anaphase A and B inhibited movement of the chromosome fragment to its pole. As a result, the trapped chromosome fragments were (1) incorporated into the opposite daughter cell, (2) lost in the cleavage furrow during cytokinesis, or (3) eventually incorporated into the correct daughter cell. These results indicate that optical traps are effective in holding laser-dissected chromosome fragments throughout mitosis. This new tool should be useful for studies on chromosome movement and cell genetics.

Animals↗

PubMed1977

Coagulant fractions of snake venom and the control of capillary bleeding during microsurgery of the ear in vivo demonstration.

In 398 cases of observed capillary bleeding out of total of 968 otological microsurgeries, the i.v. use of Bothrops Jararaca enzyme proved to be highly useful in controlling the bleeding in 79% of those, namely in 318 cases. We may assume that if capillary bleeding is indeed the consequence of some haemostatic deficiency, not always detectable with the routine laboratory preoperative tests, Bothrops Jararaca enzyme is extremely valuable in controlling this bleeding. If however oozing or capillary bleeding is the result of other circumstances, such as insufficient analgesia and neurolepsia, inadequate anaesthetic technique, wrong positioning of the head resulting in venous congestion of the operative region, or local fibrinolysis due to protracted microsurgery, other measures should be taken to correct these conditions which are not due to coagulation defects. Bothrops Jararaca enzyme, given by i.v. route, even in single dose of 2-6 units = 2-6 ampoules, was perfectly tolerated by all the patients without any side effect or allergic manifestations.

Adult↗

PubMed1988

Combined therapy with isoprinosine and CO2 laser microsurgery for the treatment of laryngeal papillomatosis.

Recurrent laryngeal papillomas and their potential malignant degenerations in adult patients have been known clinically for about 100 years. An early effective treatment has great importance in preventing possible obstruction of the airway or malignant change. The use of endoscopic microsurgery with the CO2 laser has resulted in a significant improvement in the eradication of papillomatous nodules. The advantages of laser surgery are: better visualization of the larynx to allow more precise and deeper resection of papillomas, limited bleeding, and a reduced possibility of seeding uninvolved mucosa. Although laser surgery is the current method of choice for treating laryngeal papillomatosis, it has not solved completely the problems of recurrences. To make treatment more effective, we have developed a therapeutic regimen that combines laser microsurgery with the immunostimulant methisoprinol (Isoprinosine). Our observations in 18 patients have shown that this combined management was more successful than using a single modility with either the laser or Isoprinosine alone. The combined approach was also effective in recurrent cases, with the timing of the combination influencing the results of the treatment given.

Adolescent↗

PubMed1988

Training program for transanal endoscopic microsurgery.

Televised endoscopy and the concept of the "assisted" endoscopic operation is of great help in teaching surgical endoscopic techniques. The use of training dummies provides a new method of training manual dexterity and surgical skills in special courses or in surgical skill laboratories. We have developed a training system for transanal endoscopic microsurgery. Operations with our technique were performed on 116 patients. Like other microsurgical techniques, our method requires a special introduction and intensive training. This paper presents our multistage, video-supported training course for teaching transanal endoscopic microsurgery. The one-day training session is divided into four steps: (1) becoming acquainted with the technology; (2) training on cloth phantom; (3) training on opened bowel; (4) training on closed bovine bowel distended by gas insufflation. Each step is introduced by a short videotape didactically demonstrating the particular aspects of the method.

Colonoscopy↗

PubMed1988

Factors influencing the success of microsurgery for distal tubal occlusion.

Ninety-three infertile women with distal tubal occlusion were subjected to salpingostomy in 1982-1984. In 78 of them follow-up data were available for 2-5 years. Second look laparoscopy was performed in 47 patients at a median of 4 months postoperatively. It showed one or both tubes patent in 45 (96%). In the total series of 93 patients, 13% had live births, 7.5% spontaneous abortions, and 13% ectopic pregnancies. Severe adnexal adhesions and the extent of fimbrial damage found at operation or at second look laparoscopy were the most significant factors related to the poor outcome of microsurgery. Our experience suggests that cases with severe adhesions and poor tubal status should be primarily directed to in vitro fertilization program rather than to microsurgery.

Adult↗

PubMed1997

Toward robot-assisted vascular microsurgery in the retina.

BACKGROUND: Experimental protocol in our laboratory routinely requires the precise placement of instruments at, or near, the retina. Although manipulators for placing an instrument within the eye presently exist, none of the designs were satisfactory due to limitations on size, accuracy and operability. To overcome these limitations, we have developed a novel six degree of freedom manipulator designed specifically for retinal microsurgery. METHODS: The manipulator is parallel in structure and provides submicrometer positioning of an instrument within the constrained environment of the eye. The position of an instrument attached to the manipulator is commanded by the operator using a hand-held trackball. A computer controller interprets the trackball input and moves the manipulator in an intuitive manner according to mathematically constrained modes of operation. RESULTS: Over 50 retinal vessels in the live, anesthetized cat have been successfully cannulated for pressure measurement and drug injection using the described manipulator and micropuncture techniques. The targeted vessels ranged in internal diameter from 20 to 130 microns. CONCLUSION: This device has applications in microsurgery where tremor and fatigue limit the performance of an unaided hand and where mechanically constrained manipulators are inappropriate due to size and operative constraints.

Animals↗