Arthroscopic Treatment: Layout of the Operating Room Surgical Approaches—Lateral

2016 ◽  
pp. 425-437
Author(s):  
Thomas G. Sampson
Keyword(s):  
Operating Room ◽  
Arthroscopic Treatment ◽  
Surgical Approaches

scholarly journals 3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery

2021 ◽  
Vol 12 ◽  
pp. 213
Author(s):  
Vadim Byvaltsev ◽  
Roman Polkin ◽  
Dmitry Bereznyak ◽  
Morgan B. Giers ◽  
Phillip A. Hernandez ◽  
...  
Keyword(s):  
Operating Room ◽  
3D Models ◽  
Surgical Approaches ◽  
Hand Position ◽  
Rigid Fixation ◽  
Training Models ◽  
Operating Field ◽  
Skull Model ◽  
3D Printed ◽  
Aortic Anastomosis

Background: The skills required for neurosurgical operations using microsurgical techniques in a deep operating field are difficult to master in the operating room without risk to patients. Although there are many microsurgical training models, most do not use a skull model to simulate a deep field. To solve this problem, 3D models were created to provide increased training in the laboratory before the operating room, improving patient safety. Methods: A patient’s head was scanned using computed tomography. The data were reconstructed and converted into a standard 3D printing file. The skull was printed with several openings to simulate common surgical approaches. These models were then used to create a deep operating field while practicing on a chicken thigh (femoral artery anastomosis) and on a rat (abdominal aortic anastomosis). Results: The advantages of practicing with the 3D printed models were clearly demonstrated by our trainees, including appropriate hand position on the skull, becoming comfortable with the depth of the anastomosis, and simulating proper skull angle and rigid fixation. One limitation is the absence of intracranial structures, which is being explored in future work. Conclusion: This neurosurgical model can improve microsurgery training by recapitulating the depth of a real operating field. Improved training can lead to increased accuracy and efficiency of surgical procedures, thereby minimizing the risk to patients.

Methicillin-Resistant Staphylococcus aureus Infection Is a Risk Factor for Unplanned Return to the Operating Room in the Surgical Treatment of a Septic Knee

2017 ◽  
Vol 30 (09) ◽  
pp. 872-878 ◽  
Author(s):  
Timothy Costales ◽  
Patrick Greenwell ◽  
Matthew Christian ◽  
Ralph Henn ◽  
David Jaffe
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Surgical Treatment ◽  
Operating Room ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Arthroscopic Treatment ◽  
Methicillin Resistant ◽  
Open Treatment ◽  
Open Arthrotomy

AbstractSurgical irrigation and debridement is the mainstay of treatment after the diagnosis of a septic knee. Arthroscopic treatment has been validated as a treatment option, but there is limited literature comparing it to an open arthrotomy regarding risk factors for failing single-stage surgical treatment. A retrospective review of surgically treated native adult septic knees at one urban tertiary care center was conducted to evaluate rates of unplanned return to the operating room (OR) following both arthroscopic and open treatment of an adult septic knee. The primary outcome studied was unplanned return to the OR for persistent infection within 4 months of the initial surgery. Demographics, laboratory, and microbiology data were collected to identify factors associated with unplanned return visits to the OR. Fisher's exact tests and two-tailed paired Student's t-tests were used for categorical and continuous data comparisons, respectively. A multivariate analysis was performed to identify independent risk factors of initial washout failure. Thirty-three patients underwent arthroscopy and 47 had open arthrotomy. Eight failed arthroscopy and nine failed open treatment (75.8 and 80.9% success rates, p = 0.59). Unplanned repeat washouts in arthroscopically treated knees was associated with methicillin-resistant Staphylococcus aureus (MRSA) (62.5 vs. 12%, p = 0.01) and increased synovial white blood cell (WBC) count (160,000 vs. 52,000, p = 0.004). Unplanned return for repeat washout after open treatment was associated with lower American Society of Anesthesiologists scores (2.3 vs. 2.9, p = 0.019). MRSA was the only independent predictor of failure of single washout in a multivariable logistic regression analysis (p = 0.017). This study did not detect a difference in success of single washout between arthroscopic and open treatment of septic arthritis. However, MRSA was identified as a risk factor for an unplanned return to the OR after arthroscopic treatment. Consideration should be made for open surgical treatment in the setting of MRSA infections of a native knee.

Cost comparison of laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 402-402
Author(s):  
R. L. O'Malley ◽  
T. Kowalik ◽  
M. H. Hayn ◽  
T. B. Collins ◽  
H. L. Kim ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operating Room ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Cost Comparison ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Robot Assisted ◽  
Renal Masses

402 Background: Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason for the discrepancy is the desire for minimally invasive surgical approaches but limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and may also do so for PN, although some believe costs may be prohibitive. The purpose of this investigation was to quantify the cost of robot-assisted PN (RAPN) compared to laparoscopic PN (LPN). Methods: An institutional renal tumor database was used to identify consecutive patients with normal renal function who underwent RAPN for a localized renal mass by a single surgeon who had performed < 25 previously. The 35 RAPN patients were compared to the last 35 similar patients who underwent LPN by a surgeon who had performed > 150 previous LPNs. Surgical outcomes were compared. Because room time, length of stay and Cxs were similar, cost was compared based only on the total operating room charges (ORC). Total ORC included surgeon and anesthesia fees, as well as labor and supply costs. The depreciation of the robot was included in the ORC as a higher per unit time charge than for LPN. Data on charges were available for the first 29 RAPN patients which were then compared to the last 29 LPN patients. Results: Dates of operation ranged from October 2008 to July 2009 for LPN and January 2010 to August 2010 for RAPN. Patient and tumor characteristics were similar between groups, except tumor size, which was larger in the RAPN group (3.6 ± 1.8 cm vs. 2.7 ± 0.9 cm, p = 0.007). Cxs, surgical and oncologic outcomes were similar. Mean ORC (IQR) for the LPN group was $28,606 (4,796) and for the RAPN group was $30,874 (20,389) representing a difference of $2,269. If you subtract an additional $858 for the average yearly inflation rate (3%), the difference is $1,411. Conclusions: RAPN is a safe option with perioperative outcomes similar to those of LPN performed by an experienced surgeon. A cost difference of $2,269 per procedure as estimated using ORC may decrease as the experience of the operating room staff and surgeon increase. No significant financial relationships to disclose.

Biomedical applications: Pitfalls in the practice

1994 ◽  
Vol 52 ◽  
pp. 378-379
Author(s):  
J. D. Shelburne ◽  
Peter Ingram ◽  
Victor L. Roggli ◽  
Ann LeFurgey
Keyword(s):  
Operating Room ◽  
Liquid Nitrogen ◽  
Lung Tissue ◽  
Biomedical Applications ◽  
Microprobe Analysis ◽  
Tissue Sample ◽  
Cellular Level ◽  
Tissue Samples ◽  
Asbestos Fibers

At present most medical microprobe analysis is conducted on insoluble particulates such as asbestos fibers in lung tissue. Cryotechniques are not necessary for this type of specimen. Insoluble particulates can be processed conventionally. Nevertheless, it is important to emphasize that conventional processing is unacceptable for specimens in which electrolyte distributions in tissues are sought. It is necessary to flash-freeze in order to preserve the integrity of electrolyte distributions at the subcellular and cellular level. Ideally, biopsies should be flash-frozen in the operating room rather than being frozen several minutes later in a histology laboratory. Electrolytes will move during such a long delay. While flammable cryogens such as propane obviously cannot be used in an operating room, liquid nitrogen-cooled slam-freezing devices or guns may be permitted, and are the best way to achieve an artifact-free, accurate tissue sample which truly reflects the in vivo state. Unfortunately, the importance of cryofixation is often not understood. Investigators bring tissue samples fixed in glutaraldehyde to a microprobe laboratory with a request for microprobe analysis for electrolytes.

Surgical Approaches to the Brain Stem

1993 ◽  
Vol 4 (3) ◽  
pp. 457-468 ◽  
Author(s):  
Dennis Y. Wen ◽  
Roberto C. Heros
Keyword(s):  
Brain Stem ◽  
Surgical Approaches ◽  
The Brain

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

From the research lab to the operating room

2009 ◽  
Author(s):  
Sadie F. Dingfelder
Keyword(s):  
Operating Room
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