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At least 19 recordsLinked to original sources
PubMed2004

Minimally invasive surgery.

Minimally invasive surgery is replacing the traditional open surgical approach for many abdominal procedures. The benefits of reduced pain, quicker return of oral intake, shorter hospitalizations, and improved cosmetic results all support the increasing use of the laparoscopic approach. This review identifies important articles published in the literature on minimally invasive surgery from June 2002 to August 2003, with the objective of identifying future trends and directions in laparoscopic surgery. The topics of articles reviewed in detail include minimally invasive techniques applied to esophageal tumors, morbid obesity, malignant liver tumors, gallbladder disease, pancreatic pathology, colon cancer, and robotic prostatectomy.

Anastomosis, Roux-en-Y↗
PubMed2004

Anesthesia for minimally invasive surgery.

Minimally invasive surgery has become the surgical approach of choice for a number of operative procedures in adults, but remains a challenge in children, especially the youngest, due to the physiologic changes that occur during the procedure as well as limitations posed by equipment. These surgical techniques can present unique problems to the pediatric anesthesiologist in designing and implementing the anesthetic management plan. In this article, we will outline the physiologic impact, anesthetic management, and potential challenges and complications associated with minimally invasive surgery in children.

Adolescent↗
PubMed2004

Distributed network imaging and electrical impedance tomography of minimally invasive surgery.

Minimally invasive surgery has become highly dependent on imaging. For instance, the effectiveness of cryosurgery in treating cancer is dependent on knowledge of freezing extent, and relies on real-time imaging techniques for monitoring. However, medical imaging is often very expensive and therefore not available to most of the world population. Here we propose the concept of distributed network imaging (DNI) which could make medical imaging and minimally invasive surgery available to all who need these advanced medical modalities. We demonstrate the concept through electrical impedance tomography (EIT) of cryosurgery. The central idea is to develop an inexpensive measurend (data collection hardware) at a remote site and then to connect the measurend apparatus to an advanced image reconstruction server, which can serve a large number of distributed measurends at remote sites, using existing communication conduits (Ethernet, telephone, satellite, etc.). These conduits transfer the raw data from the measurend to the server and the reconstructed image from the server to the measurend. Electrical impedance tomography (EIT) is an imaging modality which utilizes tissue impedance variation to construct an image. The EIT measurend which consists of electrodes, a power supply, and means to measure voltage is inexpensive, and therefore suitable for DNI. EIT is also very well-suited to imaging cryosurgery since frozen tissue impedance is much higher than that of unfrozen tissue. In this study, we first develop numerical models to illustrate the theoretical ability of EIT to image cryosurgery. We begin with a simplified two dimensional model, and then extend the study to the more appropriate three dimensional model. Our simulated finite element phantoms and pixel-based Newton-Raphson reconstruction algorithms were able to produce easily identifiable images of frozen regions within tissue. Then, we demonstrate the feasibility of the DNI concept though a case study using EIT to image an in vitro liver cryosurgery procedure through a modem. We find that the acquired raw data packets are less than 5KB per image and the images, using compression, do not exceed 50KB per image.

Algorithms↗
PubMed2004

Anastomotic devices for minimally invasive surgery.

Minimally invasive surgery (MIS) has had a tremendous impact on surgical practice in the last decades. For gastrointestinal surgery, construction of an anastomosis is often a critical part of the operation. Several technologies are used to perform an anastomosis in MIS. From smaller modifications of standard suturing techniques to the use of complex robotic surgery, suturing is still an essential part of MIS in this context. Stapling techniques have been adopted and modified from conventional open surgery. In the future, even more MIS procedures will be performed, especially if cancer surgery becomes more widely accepted. Further developments in MIS anastomotic techniques can be anticipated.

Journal Article↗
PubMed1998

Christoudias tissue approximator grasper: a step forward in minimally invasive surgery.

Minimally invasive surgery has become the dominant surgical procedure for cholecystectomy and many gynecological procedures. It is also gaining ground over the conventional procedures of herniorrhaphe, appendectomy. pelvic lymph node dissections, colectomies. lysis of adhesions, abdominal explorations, spleenectomy as well as thoracic, vascular and coronary bypass, and cardiac procedures.

Journal Article↗
PubMed1993

[Anesthesiologic aspects of minimally invasive surgery].

Minimal invasive, or more specifically laparoscopic surgery is now the standard procedure in an increasing number of surgical specialties. Inflating the abdomen with CO2 for long periods confronts the anesthesiologist with a number of problems that influence the choice of anesthetic and the monitoring deemed necessary. The increased intraabdominal pressure (IAP) and for some operations the extreme Trendelenburg position can disturb alveolar ventilation and compromise oxygenation. Pulse oximetry is therefore required to recognize and counteract these effects. The insufflated CO2 is absorbed into the blood to an unpredictable extent, and must be eliminated via the lungs by increasing the minute ventilation. Only capnometry or serial blood gas analyses can provide the information needed to correctly adjust the respiration. The endocrine stress reactions to laparoscopic surgery do not appear to be less pronounced than after conventional operations; only the interleukin-6 response to laparoscopic cholecystectomy is reduced compared to the subcostal incision. But minimal invasive surgery offers an advantage at least for cholecystectomy in that there is less impairment of postoperative respiratory function. General anesthesia will be the method of choice for laparoscopic surgery in all but a few procedures in which regional anesthesia is an acceptable alternative. Balanced anesthesia or total intravenous anesthesia is to be preferred, and the drugs employed should have rapid elimination kinetics with a short recovery time, since wound closure time is drastically reduced. Inhalational anesthesia alone may inhibit hypoxic pulmonary vasoconstriction thereby unduly increasing oxygen desaturation. The necessary degree of muscle relaxation still remains to be defined.

Anesthesia, Conduction↗
PubMed1998

Extending the limits: minimally invasive surgery.

Minimally invasive technology is being applied to an increasing number of surgical procedures. It remains to be seen which techniques will eventually become a 'gold standard' as has the laparoscopic cholecystectomy, and which will fall by the wayside. In the meantime, anesthesiologists must be aware of the unique requirements and complications of laparoscopic surgery.

Journal Article↗
PubMed2002

Progress in ascending and aortic arch surgery: minimally invasive surgery, blood conservation, and neurological deficit prevention.

BACKGROUND: Herein are described recent developments in aortic surgery techniques and the improved results. METHODS: Of 403 ascending and aortic arch operations, 68 patients underwent minimally invasive aortic surgery including 23 for aortic dissection, 5 for Marfan syndrome, 29 reoperations, and 39 with hypothermic arrest. Blood conservation methods were used in 187 of the 403 patients (46.5%). Aortic valve procedures were used in 267 (66.2%), including 51 (12.7%) valve-preserving operations. A protocol for stroke and neurocognitive deficit prevention was used in an attempt to prevent neurologic deficits. Data were prospectively collected and included new neurocognitive events either by formal testing (n = 35) or by informal questioning. RESULTS: Stroke occurred in 2.0% (8 of 403); clinical gross neurocognitive deficits in 2.5% (10 of 403) with a 98% 30-day survival. For those patients undergoing the minimally invasive operation 1 hospital death occurred (98.5% survival). Homologous operative transfusions were required in only 12% of blood conservation patients (23 of 187) and their postoperative intubation time, intensive care unit (ICU) stay, and hospital stay were significantly shorter (p < 0.04). CONCLUSIONS: Minimally invasive surgery is particularly useful for reoperations. The blood conservation methods appear to be beneficial and the number of neurologic deficits is low with the current protocol.

Aortic Dissection↗
PubMed2005

Prospective assessment of the use of enamel matrix proteins with minimally invasive surgery.

BACKGROUND: Minimally invasive surgery (MIS) is a surgical technique using very small incisions, indicated for performing regenerative therapy in periodontal defects. Enamel matrix proteins (EMP) have been shown to enhance periodontal regeneration. This study was undertaken to determine the effect of using EMP in combination with an MIS approach. METHODS: Patients from two private periodontal practices with chronic periodontitis who, following non-surgical therapy, had one or more sites with probing depths (PD) of > or =6 mm were included in the study. An MIS approach was utilized for surgical access. Following surgical debridement, EMP was placed into the bony defect. The surgical sites were reevaluated after at least 11 months. RESULTS: Surgical treatment was performed at 160 sites in 16 patients. No significant differences were noted in the results between the two offices and the data were combined. Mean PD reduction (P = 0.002) and attachment level improvements (P = 0.012) were significantly greater than 3 mm with mean post-surgical PD of 3.17 mm and attachment levels of 4.05 mm, based on subject means. Mean change in recession following surgery was negligible (0.01 mm). All sites were considered to be clinically successful. CONCLUSION: The combination of MIS and EMP yields significant reductions in probing depths and improvements in attachment levels while producing little or no increase in recession.

Acid Etching, Dental↗
PubMed1996

Tactile optical sensor for use in minimal invasive surgery.

In minimal invasive surgery high sensory palpation of the organs is largely lost. It is the purpose of this work to recover tactile sensing for the surgeon. To achieve this goal, a new tactile optical pressure sensor has been developed which allows to display 64 measuring points on a 0.64 cm2 surface area with a digital resolution of 12 bits. The sensor has been conceived for application in laparoscopic grasping forceps and can also be integrated into a sensing rod, both 15 mm in outside diameter. This optical sensor allows us to display graphically indurations spread in the tissue. Furthermore, the measured values serve to activate a vibrotactile display unit for tactile feedback onto the surgeon's fingertip. In order to obtain further information about the requirements for an analog tactile display, an actuatorarray with 144 pins on a 4 cm2 surface area was built. The array allows various test objects to be recognized in a true scale presentation by exploratory movements of the fingers.

Computer Graphics↗
PubMed1991

[Training program for minimally invasive surgery].

Currently 'Minimally Invasive Surgery' (MIS) is rapidly finding a widening range of applications and increasing numbers of surgical departments start with new MIS techniques. Surgical work under endoscopic control requires an intensive readjustment to operation technique bringing about new problems in training. We believe that intensive training of MIS procedures on suitable training phantoms should be a prerequisite for clinical application of MIS and therefore have established a training center for MIS in Tübingen, FRG, offering weekly hands on training courses for different procedures.

Curriculum↗
PubMed1995

[Educational opportunities in minimally invasive surgery].

Since minimally invasive surgery makes high demands on the skill, concentration and endurance of the surgeon, requisite training in this operating technique is of overriding importance. Basic training on pelvitrainers serves to enable the participant to become acquainted with the instruments and the video technique and to gain experience in handling the camera. A realistic simulation of intraoperative situations is not possible. With pulsatile organ perfusion (POP) nearly all abdominal, thoracic, vascular, urological and gynecological surgical procedures, as well as the encountered complications, can be imitated, widely replacing the need for animal experiments. Complex operations which are bound to anatomical structures, have to be practised on anaesthetized animals, as before.

Animals↗
PubMed1998

Limited access atrial septal defect closure and the evolution of minimally invasive surgery.

While minimizing the "invasiveness" in general surgery has been equated with minimizing "access", what constitutes minimally invasive intra-cardiac surgery remains controversial. Many surgeons doubt the benefits of minimizing access when the need for cardiopulmonary bypass cannot be waived. Recognizing that median sternotomy itself does entail significant morbidity, we investigated the value of alternative approaches to median sternotomy using atrial septal defect closure as our investigative model. We believe that some, but not all minimal access approaches are associated with reduced postoperative morbidity and enhanced recovery. Our current strategy is to use a mini-sternotomy approach in adult patients, whereas conventional median sternotomy remains our standard approach in the pediatric population. Considerable clinical experiences coupled with documented clinical benefits are fundamental before a certain approach is adopted in routine practice.

Adult↗
PubMed2003

From the operating room of the present to the operating room of the future. Human-factors lessons learned from the minimally invasive surgery revolution.

The minimally invasive surgical revolution has changed the way surgery is practiced. It has also helped surgical innovators to break the tethers that anchored the practice of surgery in an early 20th century operating room environment. To some in surgery, the Operating Room of the Future will be seen as a revolution but to others, an inevitable evolution of the changes ushered in by the adoption of minimally invasive surgery. Although minimally invasive surgery has conferred considerable advantages on the patient, it has imposed significant difficulties on the surgeon, which in turn, have impacted outcomes. These difficulties were primarily human factor in nature and were poorly understood by critical groups such as device manufacturers, surgeons, and surgery educators and trainers. This article details what these human factors were, how they related to the practice of minimally invasive surgery, and how they will impact on the practice of surgery in the Operating Room of the Future. Much of the technology for the Operating Room of the Future currently exists (eg, surgical robotics, virtual reality, and telemedicine). However, for it to function optimally it must be integrated in a fashion that takes on board the human factor strengths and limitations of the surgeon. These advanced technologies should then be harnessed to optimize surgical practice. In some cases, this will involve rethinking existing technologies (ie, three-dimensional camera systems), applying technologies that currently exist in a manner that is more systematic and better managed (ie, surgical robots and virtual reality), and a reconsideration of who should be applying these technologies for the practice of surgery in the 21st century. In all cases, there will be education and training implications for the practitioner. Lastly, there must be unequivocal demonstration that these changes bring about positive benefits for patients in terms of better outcomes and for surgeons in terms of ability and ease of doing their job. After the experiences of the last decade with minimally invasive surgery, the Operating Room of the Future should be seen as a well-grounded evolution, not a revolution.

Human Characteristics↗
PubMed2004

Camera and instrument holders and their clinical value in minimally invasive surgery.

During minimally invasive procedures an assistant is controlling the laparoscope. Ideally, the surgeon should be able to manipulate all instruments including the camera him/herself, to avoid communication problems and disturbing camera movements. Camera holders return camera-control to the surgeon and stabilize the laparoscopic image. An additional holder can be used to stabilize an extra laparoscopic instrument for retracting. A literature survey has been carried out giving an overview of the existing "robotic" and passive camera and instrument holders and, if available, results of their clinical value. Benefits and limitations were identified. Most studies showed that camera holders, passive and active, provide the surgeon with a more stable image and enables them to control their own view direction. Only the passive holders were suitable for holding instruments. Comparisons between different systems are reviewed. Both active and passive camera and instrument holders are functional, and may be helpful to perform solo-surgery. The benefits of active holders are questionable in relation to the performance of the much simpler passive designs.

Equipment Design↗
PubMed1994

Special section: minimally invasive surgery.

The minimally invasive surgical revolution has brought great benefits to patients and healthcare providers alike. Along with the successes have come some challenges, particularly for those who must clean and reprocess the reusable parts of scopes of all types. We have put together this special section to highlight some of the ways manufacturers of scopes, instruments, cleaning equipment and solutions have endeavored to make processing easier. This section is not all-inclusive, but it should give those facilities with continuing scope reprocessing problems a helping hand.

Catalogs, Commercial as Topic↗