Safe and simple method for secondary tracheoesophageal puncture using curved forceps

2008 ◽  
Vol 123 (10) ◽  
Author(s):  
N P Trivedi ◽  
V Kekatpure ◽  
M A Kuriakose ◽  
S Iyer
Keyword(s):  
Surgical Technique ◽  
Complication Rate ◽  
Guide Wire ◽  
Posterior Wall ◽  
Neck Extension ◽  
Simple Method ◽  
Small Incision ◽  
Operative Complications ◽  
Tracheoesophageal Puncture ◽  
Made In

AbstractIntroduction:Secondary tracheoesophageal puncture is sometimes difficult and has a higher complication rate. In the irradiated neck, where neck extension is difficult, the traditional tracheoesophageal puncture method of insertion with a rigid endoscope is not possible. We describe a simple, safe and effective alternative method of tracheoesophageal puncture using curved forceps (Kocher's curved intestinal clamp forceps or Mixter forceps).Surgical technique:The procedure is performed under local or general anaesthesia with equal ease. Maximum neck extension is achieved. The curved intestinal forceps are passed through the mouth into the oesophageal lumen. The instrument tip can easily be seen or felt at the posterior wall of the tracheostoma. A small incision is made in the mucosa to allow the forceps tip to emerge, and a guide wire is passed through this incision out of the mouth. The prosthesis can be guided over the guide wire, in retrograde fashion, to fit the puncture hole.Results:Secondary tracheoesophageal puncture was performed in five cases with severe neck fibrosis. In all cases, valve insertion was easily achieved after secondary tracheoesophageal puncture, without any peri-operative complications.Conclusion:This is a safe, simple and effective method for secondary tracheoesophageal puncture. It can be performed easily in any setting and is not associated with any complications.

Surgical Technique to Retract the Tentorial Edge during Subtemporal Approach: Technical Note

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-E408-ONS-E408 ◽  
Author(s):  
Juha Hernesniemi ◽  
Keisuke Ishii ◽  
Ayse Karatas ◽  
Leena Kivipelto ◽  
Mika Niemelä ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Senior Author ◽  
Technical Note ◽  
The Other ◽  
Middle Fossa ◽  
Trochlear Nerve ◽  
Simple Method ◽  
Subtemporal Approach ◽  
Free Margin ◽  
Small Incision

Abstract OBJECTIVE: To describe a surgical technique to retract the tentorial edge during the subtemporal approach initially introduced and used widely by Drake and Peerless to treat distal basilar artery aneurysms. METHODS: One of the most important parts of the exposure is to reflect the edge of the tentorium downward by 1 cm or more and to tether it with a suture placed lateral to or behind the insertion of the trochlear nerve and then to the dura mater of the floor of the middle fossa. Surgical forceps or a sharp dural hook are used to elevate the tentorial edge, in front of the trochlear nerve. A small incision is made on the surface of the floor of the middle fossa using a sharp bipolar forceps, and a small straight microclip is inserted with one arm through the incision on the surface of the floor of the middle fossa and the other at the free margin of the tentorial edge. RESULTS: The method described has been used by the senior author in more than 100 operations as a simple and fast means of tethering the free margin of the tentorial edge simply and quickly. CONCLUSION: We inserted a small straight microclip with one arm through the incision on the surface of the floor of the middle fossa and the other at the free margin of the tentorial edge as a fast and simple method of retracting the tentorial edge during a subtemporal approach.

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

scholarly journals Endoscopic treatment of suprasellar cysts without hydrocephalus

2016 ◽  
Vol 18 (4) ◽  
pp. 434-441 ◽  
Author(s):  
Song-Bai Gui ◽  
Sheng-Yuan Yu ◽  
Lei Cao ◽  
Ji-wei Bai ◽  
Xin-Sheng Wang ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Success Rate ◽  
Patient Outcomes ◽  
Endoscopic Treatment ◽  
Foramen Of Monro ◽  
Image Guided ◽  
Operative Complications ◽  
Appropriate Therapy ◽  
Endoscopic Fenestration

OBJECTIVE At present, endoscopic treatment is advised as the first procedure in cases of suprasellar arachnoid cysts (SSCs) with hydrocephalus. However, the appropriate therapy for SSCs without hydrocephalus has not been fully determined yet because such cases are very rare and because it is usually difficult to perform the neuroendoscopic procedure in patients without ventriculomegaly given difficulties with ventricular cannulation and the narrow foramen of Monro. The purpose of this study was to find out the value of navigation-guided neuroendoscopic ventriculocystocisternostomy (VCC) for SSCs without lateral ventriculomegaly. METHODS Five consecutive patients with SSC without hydrocephalus were surgically treated using endoscopic fenestration (VCC) guided by navigation between March 2014 and November 2015. The surgical technique, success rate, and patient outcomes were assessed and compared with those from hydrocephalic patients managed in a similar fashion. RESULTS The small ventricles were successfully cannulated using navigational tracking, and the VCC was accomplished in all patients. There were no operative complications related to the endoscopic procedure. In all patients the SSC decreased in size and symptoms improved postoperatively (mean follow-up 10.4 months). CONCLUSIONS Endoscopic VCC can be performed as an effective, safe, and simple treatment option by using intraoperative image-based neuronavigation in SSC patients without hydrocephalus. The image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of hydrocephalus in patients with SSC may not be a contraindication to endoscopic treatment.

A Simple Method for Phase-contrast Microscopy: Improvements in Technique

1949 ◽  
Vol s3-90 (11) ◽  
pp. 323-329
Author(s):  
JOHN R. BAKER ◽  
D. A. KEMPSON ◽  
P.C. J. BRUNET
Keyword(s):  
Phase Contrast ◽  
Magnesium Fluoride ◽  
Phase Plate ◽  
Dark Phase ◽  
Phase Contrast Microscopy ◽  
Simple Method ◽  
Contrast Microscopy ◽  
Bull's Eye ◽  
Made In

The following are the main improvements that we have made in the method of phase-contrast microscopy described by Kempson, Thomas, and Baker (1948): 1. No bull's-eye condenser is used. The illuminant is an electric bulb with a ‘porcelain-processed’, ‘flashed white’, or ‘opal’ surface. 2. No oiled paper is placed over the illuminating annulus. 3. The thickness of the deposit of magnesium fluoride on the phase-plate is controlled by observations on the interference colours given by surface reflections. 4. Positive (dark) phase-contrast is preferred for most purposes to negative (bright).

scholarly journals Video laryngoscopy-assisted secondary tracheoesophageal puncture placement for the patient with severely limited neck extension

2011 ◽  
Vol 122 (1) ◽  
pp. 134-136 ◽  
Author(s):  
Emily E. Crozier ◽  
Kevin Klein ◽  
Janis Deane ◽  
Laura E. Toles ◽  
Larry L. Myers
Keyword(s):  
Video Laryngoscopy ◽  
Neck Extension ◽  
Tracheoesophageal Puncture

A Prospective Study on Post-Operative Complications Following Thyroid Surgery Conducted in a Tertiary Care Hospital in Tirupati

2021 ◽  
Vol 8 (31) ◽  
pp. 2900-2905
Author(s):  
Sadhu Nagamuneiah ◽  
Gandikota Venkata Prakash ◽  
Sabitha P ◽  
Karthik Periyasamy ◽  
Sanjay Raj Kumar Reddy Madduri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Prospective Study ◽  
Total Thyroidectomy ◽  
General Hospital ◽  
Thyroid Surgery ◽  
Complication Rate ◽  
Wound Complication ◽  
Seroma Formation ◽  
Operative Complications ◽  
A Prospective Study

BACKGROUND Thyroidectomy is a surgical procedure which is commonly performed by surgeons worldwide, but the outcome and complication rates were mainly dependent on the surgeon’s skill and experience, indication and the extent of surgery and the number of thyroid surgeries performed at that particular centre. The aim of this study was to assess the frequency of the postoperative complications after thyroid surgery in Sri Venkateswara Ramnaraian Ruiya Government General Hospital, Tirupati. METHODS A prospective study conducted on 100 patients with thyroid swelling who attended the Sri Venkateshwara Ramnaraian Ruya Government General Hospital, Tirupati. Patient age, sex, rural/urban origin, history, diagnosis, type of surgery, laboratory investigation such as complete blood, serum calcium, thyroid function test, us culture and sensitivity test in wound infections and indirect laryngoscopy for all pre-operative patients and postoperative voice change patients. Outcomes recorded as a complication of thyroid surgery within one week. RESULTS Totally 100 patients were enrolled in the study. Thyroid enlargement was more common in females (F: M =5.6:1) presenting in 3rd and 4th decades mostly with the mean age and standard deviation were 42.92 years and 13.097 years respectively. Total thyroidectomy was the most common procedure performed (44 %) followed by hemithyroidectomy (31 %), subtotal thyroidectomies (29 %) and near total thyroidectomy (5 %). On histopathological examination most common finding was multinodular goiter (54 %) followed by nodular goiter (33 %) and malignancies (10 %). The overall postoperative complication rate was 47 %. The most common postoperative complications after thyroidectomies were seroma formation in wound complication (27 %), followed by hypocalcemia (11 %), recurrent laryngeal nerve (RLN) injury (3 %), and surgical site infection (2 %). Majority of these complications were found to be associated with total thyroidectomy, female population, and in patients with age more than 30 years. CONCLUSIONS Seroma formation in wound complication is the commonest post thyroidectomy complication. Female gender, old age, and extensive thyroid surgery were associated with increased complication rate. KEYWORDS Post-Operative Complications, Thyroid Surgery

scholarly journals Tuber-to-Anterior Process Angle (TAPA): A Cadaveric Study and Surgical Technique for Placing Axial Calcaneal Screws

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0041
Author(s):  
Kristen L. Stupay ◽  
Jorge Briceno ◽  
Brian Velasco ◽  
John Y. Kwon
Keyword(s):  
Surgical Technique ◽  
Guide Wire ◽  
Articular Surface ◽  
Plate Fixation ◽  
Operative Management ◽  
Screw Placement ◽  
Anterior Process ◽  
Starting Point ◽  
K Wires ◽  
Average Angle

Category: Ankle, Hindfoot Introduction/Purpose: Operative management of displaced intra-articular calcaneus fractures frequently involves placement of P: A screws in order to maintain calcaneal length and axial alignment. While plate fixation may still be more commonly utilized, screw-only fixation for the treatment of these fractures has been demonstrated by several authors to be safe and effective. Directing fixation from the tuber into the anterior process can be challenging. Understanding the calcaneal long-axis as it relates to the long-axis of the foot, a measurement we call the Tuber-to-Anterior Process Angle (TAPA), can facilitate the ease and accuracy of guide-wire and cannulated screw placement. The goals of this study are to define the TAPA, and to report a surgical technique which uses this angle to facilitate axial screw placement. Methods: Eight cadaver feet were utilized. A longitudinal pin was placed from the center of the posterior calcaneal tuber to the 2nd metatarsal heads. Next, the calcaneocuboid joint was exposed, and a wedge of cuboid was removed. A calcaneal pin was then placed, exiting at the center of the anterior process. The tips of two small K-wires were impacted into the medial and lateral-most aspects of the articular surface. A true axial view of each specimen was obtained. On these images, a digital line was drawn from the posterior tuber starting point and the central calcaneal pin, representing the calcaneal long-axis. The angle subtended by this line and the long-axis of the foot represents the TAPA. Digital lines were drawn between the posterior tuber starting point and the medial and lateral K-wires, and the range between their subtending angles represents the axial plane tolerance for screw placement within the anterior process. Results: The average TAPA measured 10.9 ± 1.3 degrees (range: 8.4-13.0). The average angle, as measured to the medial extent of the anterior calcaneus, measured 2.8 ± 1.3 degrees (range: 0.4-4.3). The average angle, as measured to the lateral extent of the anterior calcaneus, measured 19.0 ± 2.7 degrees (range: 15.7-22.7). Conclusion: Knowledge of the Tuber-to-Anterior Process Angle (TAPA), found to be 10.9 degrees (± 1.8 degrees) laterally deviated from the long-axis of the foot, simplifies placement of posterior-to-anterior screws in the calcaneus. Understanding this relationship reduces reliance on intraoperative axial fluoroscopy and increases operative efficiency. Furthermore, this knowledge can be applied during other procedures in which axial screw placement is performed, such as with corrective calcaneal osteotomy.

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