From February 2017 to December 2018, 20 patients (a total of 20 feet) had undergone the proposed modified Wilson-SERI osteotomy technique, for moderate hallux valgus. The mean age of patients was ...58,25 years (range 19 to 78). The hallux valgus angle (HVA), the intermetatarsal angle between first and second metatarsal bone (IMA) and the distal metatarsal articular angle (D.M.A.A) were measured. The feet were assessed based on the scoring system used by Broughton and Winson and by the American Orthopedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. All twenty one patients were followed up postoperatively for a minimum of 12 months. No patient was lost at follow-up. The mean HVA angle decreased significantly from 31,1° before surgery (range 22.9°-40°SD 5.0) at 11,2° (range 2.5° to 22.0°SD 5.3) at twelve months follow up. The mean IMA angle decreased significantly from 12,5° (range 8.0°-18.6°SD 3.8) before surgery at 7,4° (range 3.4°-14.0°SD 2.5) at twelve months follow up. The mean DMMA angle decreased significantly from 15.1° (range 5.3° to 20.0°SD 4.4) before surgery at 7,4 °(1.5° - 10.7°SD 2.5) at twelve months follow up. The mean score according to the AOFAS forefoot was increased from 22,1 (range 13-30 SD 5.0) to 88,2 (Range 77-96 SD 5.2) (p<0.0001). No complications, like dislocations, avascular necrosis of the first metatarsal and deep venous thrombosis, were observed in the post-operative period. We consider the Wilson-Seri procedure as a low cost minimal invasive and stable technique that could be a valid alternative to the various metatarsal osteotomies in the treatment of moderate hallux valgus deformity. Short term results at twelve months after surgery are quite satisfactory but further studies are necessary, to better comprehend an overall outcome of such approach in the long run.
Introduction of suture less electro sealing technologies, made its wide use in non-invasive thoracic surgery. Most important use of these methods was seen in performing video thoracoscopic lung ...resections (VTLR). The aim of the work - to access possibilities of different methods of electro sealing VTLR. Videothoracoscopic wedge resection was performed in 142 patients with different surgical pathologies of chest. Out of which 103 operations were closed methods and 39 were video-assisted. Suture less VTLR were performed with the use of electro sealing complexes: EK- 300M1, “LigaSure Valleylab” and electrosurgical instruments. Few patients with suture less methods were additionally sealed with mechanical sutures by using end staplers and traditional stitching apparatus. All the examined patient were discharged from the hospital. Average hospital stay was 7.8 days. Complications were seen in 7.7% cases. Lethality was not registered. High efficiency of VTLR for the diagnosis and treatment of solitary and disseminated lung processes of unknown etiologist and pneumothorax. No evidence in the results and effectiveness of EK 300M1 and LigaSure Valleylab in closed and video assisted methods. Criteria for the possibilities of combinations of suture less and mechanical suture in VTLR. Use of VTLR aloe us to minimize the cost of the operation. In the hospital, these methods can be used in closed and video assisted methods in VTLR, but needs further endoscopic electrosealing instruments.
Minimally invasive temporomandibular joint surgery (MITMJS) is an option for patients suffering from severe internal derangement or adhesions. To improve TMJ access, a workflow to create surgical ...templates is introduced.
A workflow to generate a dividable patient specific template based on CBCT and optical scanning to access the joint is introduced. In a first clinical trial 3 patients (6 joints) were treated by way of template-guided endoscopically-assisted TMJ therapy (3 arthrocenteses and 3 arthroscopies).
Generation and clinical use of the templates was as planned. All templates showed perfect fit and permitted instant access to the TMJ. All surgeries were performed without complications.
Template-guidance could improve the feasibility of endoscopically-assisted TMJ therapy. An important issue is the capability to dis- and remount the template during surgery. Using in-house production, costs are affordable.
This study was registered at the Ethic Committee of the Berlin Medical Chamber ( Eth-30/17 , 12/06/2017).
Background: We aimed to retrospectively investigate the short-term outcome, technical feasibility, and safety of single incision transumbilical laparoscopic colorectal surgery (SITULCS) using ...conventional laparoscopic surgical instruments.
Methods: From April 2009 to July 2012, 44 patients with colorectal tumors underwent SITULCS at our department by using conventional laparoscopic instruments. The operations included right hemicolectomy (n = 8), sigmoidectomy (n = 5), total colectomy (n = 4), anterior resection of rectal cancer (n = 23), and abdominoperineal resection of rectal cancer (n = 4). We accessed the intraperitoneal lesions by three trocars through a single triangle-shaped umbilical incision using conventional instruments.
Results: We successfully completed SITULCS without specially designed instruments. No patient was converted to multiport laparoscopic surgery or open surgery. Only one case developed intraoperative bleeding and one postoperative adhesive intestinal obstruction.
Conclusion: Our experience shows that SITULCS using conventional instruments is feasible, safe, and convenient.
Anesthetic issues for robotic cardiac surgery Bernstein, Wendy K; Walker, Andrew
Annals of cardiac anaesthesia,
2015 Jan-Mar, 2015-00-00, 20150101, 2015-01-01, Letnik:
18, Številka:
1
Journal Article
Recenzirano
Odprti dostop
As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking ...for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.
Zusammenfassung
Die Katheterablationsverfahren haben sich im Laufe der Jahre aufgrund ihrer Effektivität und ihrer geringen Invasivität etabliert und änderten die Indikationen für die chirurgische ...Behandlung. Das Haupttätigkeitsfeld der Herzchirurgie bleibt die Behandlung von Patienten mit angeborenen Herzfehlern, welche Rhythmusstörungen aufweisen und weiterer chirurgischer Therapien bedürfen. Die Kombination chirurgisch ablativer Maßnahmen unter guter Sicht mit modernen Ablationsinstrumenten, Vorhofverkleinerung durch Geweberesektion und Korrektur des Defekts mit der damit resultierenden Volumenentlastung bringen die besten Voraussetzungen für eine signifikante Reduktion der Arrhythmielast. Ähnliches gilt auch für die Behandlung von ventrikulären Tachykardien, die aus alten Narben und residualen Defekten resultieren. Besondere Aufmerksamkeit sollte den Patienten gelten, die eine Fontan-Konversion erhalten. Diese Operation ist eine einmalige Gelegenheit Volumen zu Entlasten, die Vorhofgröße zu reduzieren und gleichzeitig ablative Maßnahmen zu ergreifen, um den Sinusrhythmus herzustellen. Die Ergebnisse sind vielversprechend mit niedriger Mortalität und Morbidität, hoher Effektivität und schließlich deutlicher Verbesserung des funktionellen Status der Patienten. In geeigneten Fällen können auch minimal-invasive chirurgische Verfahren helfen, bei denen pharmakologische und die Katheterablationstherapie ineffektiv bleiben.
PDF
