High-Definition 3-D Exoscope for Micro-Laryngeal Surgery: A Preliminary Clinical Experience in 41 Patients

2021 ◽  
pp. 000348942110637
Author(s):  
Armando De Virgilio ◽  
Andrea Costantino ◽  
Giuseppe Mercante ◽  
Fabio Ferreli ◽  
Phil Yiu ◽  
...  
Keyword(s):  
Clinical Study ◽  
Ease Of Use ◽  
Prospective Clinical Study ◽  
Operating Microscope ◽  
Scrub Nurse ◽  
High Definition ◽  
Advantages And Disadvantages ◽  
Laryngeal Surgery ◽  
Real Value ◽  
The Individual

Objective: The aim of this prospective clinical study is to evaluate the feasibility of the micro-laryngeal surgery (MLS) using a 3D operating exoscope (OE) in substitution to a conventional operating microscope (OM). Methods: A total of 41 consecutive patients were included (male: 26; median age: 55.0 years; IQR: 46.0-68.0). After each procedure, the surgeon and the scrub nurse were asked to fill out a tailored questionnaire on a 3-point Likert scale (1—not acceptable, 2—acceptable, 3—good) including 12 items. Results: The majority of the procedures were therapeutic (n = 31, 75.6%), while the remaining were diagnostic (n = 10, 24.4%). All surgeries were successfully completed without the support of the OM, and no complications or unwanted delays were detected. The majority of the individual items were judged “good” either by surgeons (n = 399, 81.1%) and scrub nurses (n = 287, 87.5%). The natural posture during the procedure, and the ease of use the joystick and focusing were the best-rated items by the surgeons. Conclusions: This study demonstrates the feasibility of MLS using the OE. Further comparative clinical studies are needed to clarify its real value in substitution to a conventional operating microscope and to better define advantages and disadvantages.

scholarly journals Otosurgery with the High-Definition Three-Dimensional (3D) Exoscope: Advantages and Disadvantages

2021 ◽  
Vol 10 (4) ◽  
pp. 777
Author(s):  
Małgorzata Wierzbicka ◽  
Witold Szyfter ◽  
Grażyna Greczka ◽  
Wojciech Gawęcki
Keyword(s):  
Middle Ear ◽  
Three Dimensional ◽  
Chronic Otitis Media ◽  
Clinical Indication ◽  
Middle Ear Surgery ◽  
Operating Microscope ◽  
High Definition ◽  
Advantages And Disadvantages ◽  
Primary Measurement ◽  
Surgical Field

Background: The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope. Methods: The study included 60 randomly chosen patients diagnosed with otosclerosis (n = 30) or chronic otitis media (n = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope—VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope. Results: All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope. Conclusions: Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases.

Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 188-198 ◽  
Author(s):  
Reinhold ◽  
Haage ◽  
Hollenbeck ◽  
Mickley ◽  
Ranft
Keyword(s):  
Vascular Access ◽  
Central Venous ◽  
Advantages And Disadvantages ◽  
Multidisciplinary Study ◽  
First Results ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems ◽  
Arteriovenous Grafts ◽  
The Individual

In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients’ constitution, and also on the availability and experience of the involved specialists.

ADMINISTRATION MODELS IN THE SYSTEM OF FORENSIC EXAMINATION INSTITUTIONS FROM THE POSITION OF SCIENTIFIC MANAGEMENT

2016 ◽  
Vol 16 ◽  
pp. 179-184
Author(s):  
S. V. Kudryashova
Keyword(s):  
Scientific Management ◽  
Competing Values ◽  
State Institutions ◽  
Advantages And Disadvantages ◽  
Forensic Examination ◽  
Forensic Institutions ◽  
The Individual

The individual forensic activity in comparison with the activity of forensic experts of specialized state institutions is considered, the main advantages and disadvantages are determined. The directions of development of specialized state and non-state forensic institutions are presented in accordance with R. Quinn's competing values model.

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