scholarly journals Sternal Fixation with Synthes® Titanium Sternal Fixation System Using Preoperative 3-Dimensional Planning and a Patient-Specific Surgical Guide: A Pilot Study

2021 ◽  
pp. 1-3
Author(s):  
Filip W. N. Haenen ◽  
Filip W. N. Haenen ◽  
R.J. Vos ◽  
E.J. Daeter
Keyword(s):  
3D Model ◽  
Operative Time ◽  
Operating Time ◽  
Median Sternotomy ◽  
Patient Specific ◽  
Deep Sternal Wound Infection ◽  
Total Operative Time ◽  
Non Union ◽  
3 Dimensional ◽  
Fixation System

Sternal refixation or reconstruction of a median sternotomy can be indicated after treatment of deep sternal wound infection or bony non-union. Synthes® Titanium Sternal Fixation System is routinely used for sternal refixation. To perform a stable reconstruction, the titanium plates need to be bent to the anatomical shape of the sternum and adjacent ribs. The procedure offers good results, but can be, especially in the case of a complex non-union or a complex anatomy, time-consuming. Based on pre-operative CT-scan a 3D model of the sternum was printed (Materialise, Belgium). The operation was simulated using 3D software (Materialise, Belgium) and the two parts were aligned. The titanium plates were bent to fit the anatomical shape of the 3D model pre-operatively. During surgery the plates were fitted and if necessary additional bending was performed. Case 1: Total pre-operative bending time for the relatively simple anatomic shape and mal-union was 53 minutes. Total operative time was 1 hour 19 minutes. Case 2: Total pre-operative bending time for a complicated non-union and anatomy was 1 hour 21 minutes. Total operative time was 1 hour 43 minutes. Because of pre-operative bending, total operative time could be reduced by approximately 40-45%. Additional bending was rarely necessary. This case series demonstrates that the use of 3- dimensional planned patient-specific guides and preoperative preparations can help reduce operating time with satisfactory preliminary results.

Titanium Fastener Utilization during HeartMate 3 Left Ventricular Assist Device Implantation

2018 ◽  
Vol 13 (5) ◽  
pp. 361-364 ◽  
Author(s):  
Carl A. Johnson ◽  
Amber L. Melvin ◽  
Davida A. Robinson ◽  
Hossein Amirjamshidi ◽  
Peter A. Knight ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Operative Time ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Implantation Technique ◽  
Ventricular Assist ◽  
Total Operative Time ◽  
Device Implantation ◽  
Secondary Objective

Objective The objective of this study was to investigate the feasibility of using titanium fasteners for securement of the inflow sewing ring during HeartMate 3 implantation. The secondary objective was to compare cardiopulmonary bypass and total operative times between the titanium fastener and hand-tied knot groups. Methods Clearance between the sewing ring and the HeartMate 3 device was assessed in vitro. Thirty-one patients undergoing HeartMate 3 implantation via median sternotomy at a single center from April 2017 to February 2018 were reviewed. The sewing ring was secured with hand-tied knots (n = 18) or titanium fasteners (n = 13). Cannulation strategy and implantation technique were otherwise identical between groups. Central arterial and venous cannulation was performed for cardiopulmonary bypass. The left ventricular apex was cored, and the sewing ring was attached with hand-tied knots or titanium fasteners. Results There was adequate clearance for the titanium fastener to secure the inflow sewing ring and then connect to the HeartMate 3 in vitro. The inflow sewing ring was successfully secured during HeartMate 3 implantation in the titanium fastener group. Cardiopulmonary bypass time was 75 and 92 minutes for the titanium fastener and hand-tied groups, respectively ( P < 0.03). Total operative time was 177 and 193 minutes for the titanium fastener and hand-tied groups, respectively ( P = 0.513). Conclusions The inflow sewing ring of the HeartMate 3 was efficiently secured using titanium fasteners. Titanium fasteners resulted in shorter cardiopulmonary bypass times compared with the hand-tied group. There was no difference in total operative time.

In vitro validation of a 3-dimensional transrectal ultrasound system for prostate biopsiess

2007 ◽  
Vol 30 (4) ◽  
pp. 77
Author(s):  
Derek Cool ◽  
Shi Sherebrin ◽  
Jonathan Izawa ◽  
Joseph Chin ◽  
Aaron Fenster
Keyword(s):  
Prostate Biopsy ◽  
3D Model ◽  
Transrectal Ultrasound ◽  
Surface Topology ◽  
Sufficient Information ◽  
Needle Guidance ◽  
3 Dimensional ◽  
High Incidence ◽  
3D Information

Introduction: Transrectal ultrasound (TRUS) prostate biopsy (Bx) is currently confined to 2D information to both target and record 3D Bx locations. Accurate placement of Bx needles cannot be verified without 3D information, and recording Bx sites in 2D does not provide sufficient information to accurately guide the high incidence of repeat Bx. We have designed a 3D TRUS prostate Bx system that augments the current 2D TRUS system and provides tools for biopsy-planning, needle guidance, and recording of the biopsy core locations entirely in 3D. Methods: Our Bx system displays a 3D model of the patient’s prostate, which is generated intra-procedure from a collection of 2D TRUS images, representative of the particular prostate shape. Bx targets are selected, needle guidance is facilitated, and 3D Bx sites are recorded within the 3D context of the prostate model. The complete 3D Bx system was validated, in vitro, by performing standard ten-core Bx on anatomical phantoms of two patient’s prostates. The accuracy of the needle-guidance, Bx location recording, and 3D model volume and surface topology were validated against a CT gold standard. Results: The Bx system successfully reconstructed the 3D patient prostate models with a mean volume error of 3.2 ± 7.6%. Using the 3D system, needles were accurately guided to the pre-determined targets with a mean error of 2.26 ± 1.03 mm and the 3D locations of the Bx cores were accurately recorded with a mean distance error of 1.47 ± 0.79 mm. Conclusion: We have successfully developed a 3D TRUS prostate biopsy system and validated the system in vitro. A pilot study has been initiated to apply the system clinically.

Endograft Planning without Preoperative Arteriography: A Clinical Feasibility Study

2000 ◽  
Vol 7 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Hugh G. Beebe ◽  
Boonprasit Kritpracha ◽  
Sharon Serres ◽  
John P. Pigott ◽  
Charles I. Price ◽  
...  
Keyword(s):  
3D Model ◽  
Preoperative Evaluation ◽  
Spiral Ct ◽  
Side Branch ◽  
Aortic Aneurysms ◽  
Slice Thickness ◽  
Technical Success Rate ◽  
3 Dimensional ◽  
Procedural Time ◽  
Procedural Success

Purpose: To investigate an alternative method of preprocedural planning for aortic endografting based solely on spiral computed tomography (CT) with 3-dimensional (3D) reconstruction without preoperative arteriography. Methods: From August 1997 to April 1998, 25 consecutive patients with abdominal aortic aneurysms (AAA) were evaluated for endovascular repair by spiral CT scans (2-mm slice thickness) and computerized 3D model construction. No additional imaging for planning was performed. The aortoiliac dimensions, thrombus load, calcification, and vessel tortuosity were measured and evaluated from the 3D model of the aortoiliac segment. These data were used for selecting the patients; the configuration, diameter, and length of the endograft; and the attachment sites for deployment. Results: Primary procedural success was 92% (23/25). All endografts were deployed as planned, and there were no conversions to open repair. Six patients required adjunctive procedures for delivery system access or for iliac aneurysm exclusion, as predicted by the 3D model. Mean procedural time was 91 minutes (range 24 to 273). Two (8%) type II (side branch) endoleaks both sealed spontaneously within 1 month. No graft-related complications or death occurred, for a 30-day technical success rate of 100%. Conclusions: This computerized 3D model provided accurate data for preoperative evaluation of the aortoiliac segment for endovascular AAA repair. Satisfactory technical outcomes for aortic endografts can be achieved without the use of preprocedural invasive imaging.

Are operating room distractions, interruptions, and disruptions associated with performance and patient safety? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Ryan D McMullan ◽  
Rachel Urwin ◽  
Peter Gates ◽  
Neroli Sunderland ◽  
Johanna I Westbrook
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Random Effects ◽  
Team Performance ◽  
Operative Time ◽  
Meta Analysis ◽  
Individual Performance ◽  
Negative Effects ◽  
Total Operative Time ◽  
Operative Duration

Abstract Background The operating room (OR) is a complex environment in which distractions, interruptions, and disruptions (DIDs) are frequent. Our aim was to synthesise research on the relationships between DIDs and (a) operative duration, (b) team performance, (c) individual performance, and (d) patient safety outcomes; in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Methods Electronic databases (MEDLINE, Embase, CINAHL, PsycINFO) and reference lists were systematically searched. Included studies were required to report quantitative outcomes of the association between DIDs and team performance, individual performance, and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality, and extracted data. A random effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Results Twenty-seven studies were identified. The majority were prospective observational studies (n=15), of moderate quality (n=15). DIDs were often defined, measured, and interpreted differently in studies. DIDs were significantly associated with: extended operative duration (n=8), impaired team performance (n=6), self-reported errors by colleagues (n=1), surgical errors (n=1), increased risk and incidence of surgical site infection (n=4), and fewer patient safety checks (n=1). A random effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% CI 15.7-29.9). Conclusion DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

scholarly journals Securing the surgical field for mobilization of right-sided colon cancer using the duodenum-first multidirectional approach in laparoscopic surgery

2021 ◽  
Author(s):  
K. Nagayoshi ◽  
S. Nagai ◽  
K. P. Zaguirre ◽  
K. Hisano ◽  
M. Sada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Right Colectomy ◽  
R0 Resection ◽  
Medial Approach ◽  
Total Operative Time ◽  
Advanced Tumors

Abstract Background The aim of this study was to compare the short-term outcomes of the duodenum-first multidirectional approach (DMA) in laparoscopic right colectomy with those of the conventional medial approach to assess its safety and feasibility. Methods This retrospective study enrolled 120 patients who had laparoscopic surgery for right-sided colon cancer in our institution between April 2013 and December 2019. Fifty-four patients underwent colectomy using the multidirectional approach; among these, 20 underwent the DMA and 34 underwent the caudal-first multidirectional approach (CMA). Sixty-six patients underwent the conventional medial approach. Complications within 30 days of surgery were compared between the groups. Results There were 54 patients in the multidirectional group [29 females, median age 72 years (range 36–91 years)] and 66 in the medial group [42 females, median age 72 years (range 41–91 years)]. Total operative time was significantly shorter in multidirectional approach patients than conventional medial approach patients (208 min vs. 271 min; p = 0.01) and significantly shorter in patients who underwent the DMA compared to the CMA (201 min vs. 269 min; p < 0.001). Operative time for the mobilization procedure was also significantly shorter in patients who underwent the DMA (131 min vs. 181 min; p < 0.001). Blood loss and incidence of postoperative complications did not differ. In 77 patients with advanced T3/T4 tumors, the DMA, CMA, and conventional medial approach were performed in 13, 21, and 43 patients, respectively. Total operative time and operative time of the mobilization procedure were significantly shorter in patients undergoing DMA. Blood loss and incidence of postoperative complications did not differ. R0 resection was achieved in all patients with advanced tumors. Conclusions The DMA in laparoscopic right colectomy is safe and feasible and can achieve R0 resection with a shorter operative time than the conventional medial approach, even in patients with advanced tumors.

Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses

2017 ◽  
Vol 34 (01) ◽  
pp. 071-076 ◽  
Author(s):  
Linden Head ◽  
Douglas McKay
Keyword(s):  
Economic Analysis ◽  
Operative Time ◽  
Capital Expenditure ◽  
Operating Time ◽  
Free Tissue Transfer ◽  
Capital Expenditures ◽  
Purchasing Decisions ◽  
Venous Anastomosis ◽  
Literature Reviews ◽  
Economic Comparison

Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis. Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses. Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses. Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.

scholarly journals Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ricardo Brandão Fonseca ◽  
Alyne Oliveira Correia ◽  
Raysa Siqueira Vieira ◽  
José Erivaldo Fonseca dos Santos ◽  
Heverty Rocha Alves-Neto ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operative Time ◽  
Operating Time ◽  
Cerebral Aneurysms ◽  
Length Of Hospital Stay ◽  
Neurological Status ◽  
Aneurysm Rupture ◽  
Anterior Circulation ◽  
Pterional Craniotomy ◽  
Resource Setting

AbstractThe challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature. This study analyzes the viability of SOMC in the treatment of cerebral aneurysms, using exactly the same resources as pterional craniotomy (PC). The results of these two techniques are compared. 35 patients underwent SOMC, compared to 50 patients underwent CP (100 aneurysms in total), using the same microsurgical instruments. The following variables were compared: operative time, angiographic cure, length of intensive care unit stay during the post-operative period, surgical complications, length of hospital stay after surgery until hospital discharge, intraoperative aneurysm rupture, aesthetic satisfaction with the scar, and neurological status at discharge. SOMC had a significantly shorter operative time in relation to PC (213.9 ± 11.09 min and 268.6 ± 15.44 min, respectively) (p = 0.0081).With respect to the cosmetic parameters assessed by the Visual Analog Scale, the average for SOMC was 94.12 ± 1.92 points, and the average for PC was 83.57 ± 4.75 points (p = 0.036). SOMC was as effective as PC in relation to successful aneurysm clipping (p = 0.77). The SOMC technique did not show advantages over PC in any other variable. Even in a general neurosurgery service lacking a specific structure for minimally invasive surgeries, SOMC was feasible and effective for treating intracranial aneurysms, using the same set of microsurgical instruments used for PC, obtaining better results in operating time and cosmetic satisfaction.

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