Why Evolution is Better than Revolution

1997 ◽  
Vol 14 (2) ◽  
pp. 109-112
Author(s):  
Russell Knudsen
Keyword(s):  
Surgical Planning ◽  
Gradual Increase ◽  
Surgical Techniques ◽  
Staff Skills ◽  
Better Than

In the main, the development of modern hair restoration surgical techniques has involved a few revolutions and a number of small evolutions. These evolutions have improved upon earlier techniques after carefully analyzing both the benefits and shortcomings of these pioneer techniques. Longer-term shortcomings in surgical planning have equally demonstrated the potential dangers of aggressive radical technique changes. Modern megasessions require a gradual increase in graft numbers to accommodate the need for development of staff skills unique to these procedures. Innovation is important, but it is more safely expressed in gradual improvements to existing techniques.

scholarly journals Mitral commissural prolapse

2020 ◽  
Author(s):  
EVA PAPADIMITRAKI ◽  
Alexandros Patrianakos ◽  
Antonis Pitsis ◽  
Maria Marketou ◽  
Aggeliki Zacharaki ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Planning ◽  
3D Imaging ◽  
Correct Diagnosis ◽  
Surgical Techniques ◽  
Valve Repair ◽  
Accurate Identification ◽  
2D Echocardiography ◽  
2D And 3D ◽  
Echocardiographic Findings

Mitral commissural prolapse or flail, either isolated or combined with more extensive degenerative valve disease imposes several challenges both on its diagnosis and management whilst being a risk factor for valve reoperation after mitral valve repair. Accurate identification of the prolapsing segment is often not feasible with transthoracic 2D echocardiography, with transesophageal 3D imaging then required for correct diagnosis and surgical planning. Various surgical techniques employed alone or in combination, have yielded good results in the repair of commissural prolapse. Herein, we analyze the specific characteristics of commissural disease focusing our attention on 2D and 3D echocardiographic findings and we briefly comment on techniques employed for surgical correction of the disease.

Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery

2020 ◽  
Author(s):  
Taku Sugiyama ◽  
Tod Clapp ◽  
Jordan Nelson ◽  
Chad Eitel ◽  
Hiroaki Motegi ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Surgical Planning ◽  
Objective Assessment ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Decision Making Process ◽  
3 Dimensional ◽  
Head Mounted Display ◽  
Precise Understanding ◽  
Cerebrovascular Surgery

Abstract BACKGROUND Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display. OBJECTIVE To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery. METHODS A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons’ hand-drawn presurgical illustrations. RESULTS The VR session effectively enhanced surgeons’ understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons’ presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts. CONCLUSION Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons’ understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.

scholarly journals Two surgical techniques are better than one: RAVAS and RAPID are answers for the same issue

2020 ◽  
Author(s):  
Matteo Ravaioli ◽  
Guido Fallani ◽  
Matteo Cerri ◽  
Enrico Prosperi ◽  
Carla Serra ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Better Than

scholarly journals Microstructure and Mechanical Properties of Friction Stir-Welded Dissimilar Joints of ZK60 and Mg-4.6Al-1.2Sn-0.7Zn Alloys

Materials ◽  
2021 ◽  
Vol 15 (1) ◽  
pp. 23
Author(s):  
Liangwen Xie ◽  
Xianyong Zhu ◽  
Yuexiang Fan ◽  
Weijia Sun ◽  
Peng Wang ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Grain Size ◽  
Welded Joints ◽  
Gradual Increase ◽  
Tensile Fracture ◽  
Dissimilar Joints ◽  
Friction Stir ◽  
Base Materials ◽  
Transverse Tensile ◽  
Better Than

In order to clarify the microstructural evolution and the mechanical property of dissimilar friction stir-welded joints of ZK60 and Mg-4.6Al-1.2Sn-0.7Zn magnesium alloys, two types of arrangement with ZK60 at advancing side (AS) or retreating side (RS) were adopted. The macrostructure and the microstructure of the dissimilar welded joints were discussed, and the microhardness and the transverse tensile properties of the joints were measured. There are three stirring sub-zones with different compositions and two clear interfaces within the joints. Due to the effect of both the original grain size of base materials and the growth of recrystallized grains, in the stir zone (SZ), the grain size of ZK60 increased slightly, while the grain size of Mg-4.6Al-1.2Sn-0.7Zn decreased significantly. The dissolution of precipitates was gradually significant from RS to AS within the SZ due to the gradual increase in strain and heat. The grain refinement led to an increase in hardness, while the dissolution of precipitates resulted in a decrease in hardness. The performance of the joints obtained with ZK60 placed on the RS is slightly better than that of that on the AS. The tensile fracture of both joints occurred at the interface between SZ and the thermos-mechanical affected zone at the AS, and showed a quasi-dissociative fracture.

Abstract WP352: Clinical Outcomes of Patients Undergoing BrainPath-assisted Evacuation of Intracerebral Hematomas

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Min Lang ◽  
Alex M Witek ◽  
Nina Z Moore ◽  
Mark D Bain
Keyword(s):  
Clinical Outcomes ◽  
Medical Management ◽  
Surgical Intervention ◽  
Cleveland Clinic ◽  
Surgical Techniques ◽  
Surgical Morbidity ◽  
Prospective Data ◽  
Minimally Invasive Access ◽  
Better Than

Introduction: Multiple clinical trials have failed to show that surgical intervention leads to better outcomes than medical management for patients with intracerebral hemorrhage (ICH). Newer and less invasive surgical techniques have been reported to be safe and technically effective for evacuation of ICH. The purpose of this study is to evaluate clinical outcomes following ICH evacuation using the BrainPath system (NICO, Indianapolis, IN), a tool that allows minimally invasive access to the subcortical space. Methods: IRB-approved prospective data were collected on patients who underwent ICH evacuation using BrainPath at the Cleveland Clinic from August 2013 to April 2016. Glasgow Coma Score (GCS) was collected upon admission and discharge. NIH stroke score (NIHSS) and modified Rankin score (mRS) were collected upon admission and discharge, and at the 3- and 6-month months follow-up visits. Results: Thirty-five patients underwent BrainPath-assisted ICH evacuation, with a mean age of 57 ± 16 years and average ICH volume of 50.4 ± 23.5mL. Complications included two patients requiring re-operation due to hematoma re-accumulation (6%), both of whom had serum creatinine greater than 1.5, and one case of wound infection (3%). Eight (23%) patients died during the follow-up period, of which four (11%) died within 30 days of hemorrhage. GCS was 10.1 ± 3.7 on admission and improved to 11.9 ± 2.9 at discharge. NIHSS of surviving patients at pre-operation, discharge, 3-month follow-up, and 6-month follow-up were 18.6 ± 7.7 (n=35), 19.0 ± 8.7 (n=26), 7.8 ± 5.9 (n=19), and 3.7 ± 3.8 (n=12), respectively. mRS at pre-hemorrhage baseline, 3-month follow-up, and 6-month follow-up was 0.7 ± 1.2 (n=35), 4.3 ± 1.5 (n=30), and 3.9 ± 1.9 (n=26), respectively. Conclusions: Evacuation of ICH using BrainPath is associated with acceptable rates of surgical morbidity. The 30-day mortality rate was better than expected based on admission ICH scores. Patients showed improvement in GCS between admission and discharge, and they showed improvement in NIHSS and mRS at three and six months postoperatively. A comparative study is needed to investigate whether surgical evacuation using this technique results in improved clinical outcomes compared to medical management.

Orthognathic Surgery of the Mandible

2021 ◽  
Author(s):  
Sara Bahmanyar ◽  
Arya W. Namin ◽  
Robert O. Weiss ◽  
Aurora G. Vincent ◽  
Andrew M. Read-Fuller ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Orthognathic Surgery ◽  
Orthodontic Treatment ◽  
Surgical Planning ◽  
Surgical Techniques ◽  
Preoperative Assessment ◽  
Virtual Surgical Planning ◽  
Facial Esthetics ◽  
Technological Advances

AbstractOrthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.

Impact of Preoperative 64-Slice CT Scanning on Mini-Maze Atrial Fibrillation Surgery

2007 ◽  
Vol 2 (4) ◽  
pp. 169-175 ◽  
Author(s):  
Cristopher A. Meyer ◽  
Joseph E. Hall ◽  
John R. Mehall ◽  
Randall K. Wolf ◽  
E. William Schneeberger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Surgical Planning ◽  
Pulmonary Veins ◽  
Significant Coronary Artery Disease ◽  
Surgical Techniques ◽  
Ct Scanning ◽  
Artery Disease

Background Multidetector computed tomography (MDCT) is emerging as a powerful noninvasive diagnostic tool. The appropriate role of this technique in the preoperative evaluation of cardiovascular disease has yet to be fully defined. Atrial fibrillation is the most common sustained cardiac arrhythmia, and novel minimally invasive surgical techniques have been developed to treat this condition by electrically isolating the pulmonary veins. The ideal methodology to preoperatively evaluate these patients remains debatable. We hypothesized that 64-slice CT could significantly affect perioperative planning. Methods Thirty-six consecutive patients who consented to undergo minimally invasive pulmonary vein isolation at our institution underwent a preoperative 64-slice cardiac CT scan. All cardiac and noncardiac abnormalities were recorded, and modifications to the initial surgical plan were documented. Results The mean patient age was 64.4 ± 11.9 years [26 men (72.2%), 17 with known coronary artery disease (47.2%)]. Preoperative CT scanning detected 12 patients with abnormal pulmonary venous anatomy (33.3%), 3 with left atrial thrombus (8.3%), and 17 with significant coronary artery disease (47.2%). Furthermore, 20 studies (55.6%) detected pulmonary abnormalities (including 11 nodules). Preoperative scanning significantly altered surgical planning in 10 cases (27.8%). Alterations in patient treatment included preoperative invasive angiography, conversion of the mini-maze to an open chest procedure, alteration of surgical approach, and postponement/cancellation. Conclusions Sixty-four-slice CT scanning is a safe, rapid, and accurate procedure with important ramifications for surgical planning. This methodology could become an alternative approach to screen preoperative cardiac surgical patients.

3D modeling: a future of cardiovascular medicine

2019 ◽  
Vol 97 (4) ◽  
pp. 277-286 ◽  
Author(s):  
Kaley H. Garner ◽  
Dinender K. Singla
Keyword(s):  
3D Modeling ◽  
Surgical Planning ◽  
Surgical Techniques ◽  
3D Models ◽  
Health Concern ◽  
Patient Specific ◽  
Future Directions ◽  
Medical Device Design ◽  
Significant Interest ◽  
Operative Planning

Cardiovascular disease resulting from atypical cardiac structures continues to be a leading health concern despite advancements in diagnostic imaging and surgical techniques. However, the ability to visualize spatial relationships using current technologies remains a challenge. Therefore, 3D modeling has gained significant interest to understand complex and atypical cardiovascular disorders. Moreover, 3D modeling can be personalized and patient-specific. 3D models have been demonstrated to aid surgical planning and simulation, enhance communication among surgeons and patients, optimize medical device design, and can be used as a potential teaching tool in medical schools. In this review, we discuss the key components needed to generate cardiac 3D models. We highlight prevalent structural conditions that have utilized 3D modeling in pre-operative planning. Furthermore, we discuss the current limitations of routine use of 3D models in the clinic as well as future directions for utilization of this technology in the cardiovascular field.

scholarly journals Surgical Treatment with Locoregional Flaps for the Eyelid: A Review

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Federico Lo Torto ◽  
Luigi Losco ◽  
Nicoletta Bernardini ◽  
Manfredi Greco ◽  
Gianluca Scuderi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Social Relationship ◽  
Surgical Planning ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Full Thickness ◽  
Eyelid Reconstruction ◽  
Colour Match ◽  
Full Thickness Excision ◽  
Anatomy Knowledge

Reconstruction of the eyelids after skin cancer excision can be challenging. Surgical treatment options are multiple; deep anatomy knowledge of lamellar components is mandatory to choose the most adequate surgical planning. Eyelids’ role in vision and social relationship is critical; both function and aesthetics are tough to restore. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short contraction during healing; furthermore, grafts are sometimes necessary to achieve pleasing results. Hundreds of surgical techniques have been described aiming for eyelid reconstruction; in our paper, we want to provide for our audience the most reliable and useful procedures for subtotal and total eyelid reconstruction following NMSC full-thickness excision.

scholarly journals O74: ASSESSING THE USEFULNESS OF THREE-DIMENSIONAL IMAGING AND VIRTUAL REALITY IN SURGICAL PLANNING: A MEDICAL STUDENT LED PILOT STUDY

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
C Ryan ◽  
E O'Malley ◽  
D Sheppard
Keyword(s):  
Virtual Reality ◽  
Medical Student ◽  
Pilot Study ◽  
Surgical Planning ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
3D Models ◽  
Bleeding Complications ◽  
Three Dimensional Imaging ◽  
Patient Counselling

Abstract Introduction Nephron-sparing surgery is becoming more common as surgical techniques advance. VR and 3D visualisation appear to provide better anatomical understanding in presurgical planning than two-dimensional alone. 3D models may enable greater tissue salvation and fewer complications. 3D model preparation and advancing research is expensive and time consuming. We aim to pilot study led by medical student, create reliable anatomical kidney models and assess usefulness in surgical planning. Method Routine CT urograms were performed on 128 slice scanner using split bolus technique. Medical student segmented and displayed models in VR using 3DSlicer. Radiology registrar and consultant validated models. Two urology surgeons completed qualitative questionnaires. Result We included two patients. Only minor segmentation tweaks by radiologist ensured accurately demonstrated tumors. Tissue contrast quality varied between CT scans complicating segmentation. Both surgeons deemed models helpful in visualising hilar anatomy, predicting bleeding complications, determining laparoscopic/open and partial/full nephrectomy approach. Surgeons prioritised vasculature visualisation over collecting system. Surgeons suggested gauging tumor depth would be useful. Considering 3D printing cost, surgeons agreed VR alone may suffice. Conclusion Surgeons found 3D and VR enabled accurate surgical planning and patient counselling regarding nephrectomy risk. Minor CT protocol recommendations enable easier and more accurate segmentation, without increasing patient's radiation exposure. Annual leave during 8-week summer project reflects case numbers. Since, we've identified more cases to assess surgical parameters against matched cohort. We've begun work for adrenal surgery. It's feasible for medical students with minimal surgical/radiological knowledge to advance this research, gaining valuable experience. Abbrev Virtual Reality(VR), Three-dimensional(3D), Computerised Tomography(CT) Take-home message Three-dimensional imaging and virtual reality may improve surgical planning and patient counselling. Regarding nephrectomy, this could give surgeons the confidence to convert from full nephrectomy to partial nephrectomy approach, improving patient outcome.

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