scholarly journals Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity

2022 ◽  
Vol 6 (1) ◽  
pp. V19
Keyword(s):  
Large Range ◽  
Kyphotic Deformity ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Link Type ◽  
Grade 5 ◽  
Visual Access ◽  
Intraoperative Visualization ◽  
Junctional Kyphosis

The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse). The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190

scholarly journals Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries

2021 ◽  
Vol 18 (15) ◽  
pp. 8114
Author(s):  
Anjali Joseph ◽  
David Neyens ◽  
Sahar Mihandoust ◽  
Kevin Taaffe ◽  
David Allison ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Work Zones ◽  
Convenience Sample ◽  
Operational Strategies ◽  
Team Members ◽  
Video Recordings ◽  
Safety Risks ◽  
Flow Disruptions

(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and equipment in the OR, potentially impacting workflow of surgical team members and creating patient safety risks; (2) Methods: This quantitative observational study used a convenience sample of 38 video recordings of the intraoperative phase of pediatric outpatient surgeries to study the impacts of surgical table orientation on flow disruptions (FDs), number of contacts between team members and distance traveled; (3) Results: This study found that the orientation of the surgical table significantly influenced staff workflow and movement in the OR with an angled surgical table orientation being least disruptive to surgical work. The anesthesia provider, scrub nurse and circulating nurse experienced more FDs compared to the surgeon; (4) Conclusions: The orientation of the surgical table matters, and clinicians and architects must consider different design and operational strategies to support optimal table orientation in the OR.

Twin-driven actuator with multi-layered disc magnetorheological fluid clutches for haptics

2020 ◽  
pp. 1045389X2094395 ◽  
Author(s):  
Takehito Kikuchi ◽  
Isao Abe ◽  
Tomoya Nagata ◽  
Akinori Yamaguchi ◽  
Tetsumasa Takano
Keyword(s):  
Force Control ◽  
Large Range ◽  
Magnetorheological Fluid ◽  
Basic Structure ◽  
Magnetorheological Fluids ◽  
Torque Control ◽  
Link Type ◽  
Actuation Systems ◽  
Haptic Control ◽  
Ferromagnetic Particles

Magnetorheological fluids are composite materials made of ferromagnetic particles, medium oils, and several types of additives. We have developed actuation systems for the fine haptic control of master–slave robots. In this study, we proposed a new structure of a magnetorheological fluid–based actuator suitable for haptic devices. For the basic structure of the actuator, we proposed a twin-driven magnetorheological fluid actuator using two multi-layered disc-type magnetorheological fluid clutches for haptics. We conducted performance measures for the magnetorheological fluid clutches for haptics with three commercially available magnetorheological fluids (i.e. 122EG, 132DG, and 140CG from Lord Corp.). The experimental results show that 132DG is a better material for force control. Then, we proposed two types of twin-driven magnetorheological fluid actuators (i.e. link type and belt type) and compared their performance. The results show that the averages of the time constant are 19.1 and 16.1 ms for the link type and belt type, respectively. Furthermore, the averages of torque error are 0.033 and 0.068 N m for the link type and belt type, respectively. However, the belt-type twin-driven magnetorheological fluid actuator is better if a large range of motion is required, while the link-type twin-driven magnetorheological fluid actuator is better if accurate torque control is required.

Psychosocial elements of professionally-relevant behaviour in scrub nurses

2016 ◽  
Vol 6 (3) ◽  
pp. 123-134
Author(s):  
Anna Ribakova ◽  
Liana Deklava ◽  
Kristaps Circenis ◽  
Inga Millere
Keyword(s):  
Evaluation System ◽  
Medical Equipment ◽  
Technical Skills ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Self Assessment ◽  
Team Members ◽  
Specific Behaviour ◽  
Demographic Questionnaire ◽  
Intraoperative Period

The significance of professionally-relevant behaviour of scrub nurses for teamwork in the operating room is increasing, as proven by the studies carried out over the last decades worldwide. Non-technical skills include both social and cognitive elements. Specific behaviour evaluation system can be used to identify, assess and improve non-technical skills of scrub nurses. Improvement of non-technical skills helps reduce staff errors in the intraoperative period. The objective of the research is to find out whether there are statistically significant differences between scrub nurses’ self-assessment of their non-technical skills, their implementation and surgeons' expectations. Demographic questionnaire, interview and Scrub Practitioners List of Intraoperative Non-technical Skills (SPLINT) were used in this study. Scrub nurses tend to engage in minimal communication and only a half of surgeons show expectations for exchange of thoughts and ideas from scrub nurses. This shows that the exchange of information between physicians and scrub nurses is generally insufficient. Surgical team members pay more attention to signals given by the surgical team and surgical process and rarely report on perception of signals given by medical equipment and a patient. Such data may be indicative of insufficient attention to a patient’s safety during the surgery.   Key words. Non-technical skills, scrub nurse, scrub nurse’s skills

Cervical Myelopathy

2018 ◽  
pp. 71-80
Author(s):  
Mario Ganau ◽  
So Kato ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Deformity Correction ◽  
Kyphotic Deformity ◽  
Surgical Team ◽  
Comprehensive Management ◽  
Cord Injury ◽  
Pros And Cons ◽  
Spinal Cord Decompression ◽  
Degenerative Cervical Myelopathy

Patients with kyphotic deformity and degenerative cervical myelopathy are at elevated risk for traumatic and nontraumatic spinal cord injury and require comprehensive management entailing a careful clinical assessment with dedicated functional scales and radiological study of spinal balance. Surgical strategies to address this clinical scenario including anterior, posterior, and combined approaches. Whatever the choice, the surgical plan should always envisage spinal cord decompression and stabilization along with deformity correction. The surgical team should discuss pros and cons of the most appropriate surgical plan with the patient, anticipate possible complications, and propose alternate strategies. This chapter details the most important practical aspects of surgical management, ranging from technical advantages of multiple osteotomies and selection of implants for instrumented fusion, to the surgical and anesthesiological nuances to avoid intraoperative and postoperative complications. An overview is provided of scientific literature regarding the correction of kyphotic deformity and ongoing clinical trials.

Applying the Exoscope to Lacrimal Surgery: Preliminary Experience

ORL ◽  
2021 ◽  
pp. 1-6
Author(s):  
Francesca Pirola ◽  
Armando De Virgilio ◽  
Alessandra Di Maria ◽  
Elena Russo ◽  
Matteo Di Bari ◽  
...  
Keyword(s):  
New Technology ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Team Members ◽  
Ethical Committee Approval ◽  
Secondary Endpoints ◽  
Surgical Field

Purpose: The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR). Materials and Methods: In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as “good” = 2, “acceptable” = 1, and “not acceptable” = 0). A questionnaire score of 24 out of 24 was valued as “completely approved,” score 20–23 as “moderately approved,” and score ≤19 as “weakly approved.” Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained. Results: No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20’ vs. 23’, respectively, p = 0.091). The exoscope was valued by surgical team members as “completely approved” in 55.5% of cases, “moderately approved” in 39.7%, and “weakly approved” in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively). Conclusions: The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.

scholarly journals Surgeon and staff radiation exposure in minimally invasive spinal surgery: prospective series using a personal dosimeter

2020 ◽  
Vol 32 (6) ◽  
pp. 817-823 ◽  
Author(s):  
Jakub Godzik ◽  
George M. Mastorakos ◽  
Gautam Nayar ◽  
William D. Hunter ◽  
Luis M. Tumialán
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Real Time ◽  
Spinal Surgery ◽  
Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Radiation Awareness ◽  
Personal Dosimeter

OBJECTIVEThe level of radiation awareness by surgeons and residents in spinal surgery does not match the ubiquity of fluoroscopy in operating rooms in the United States. The present method of monitoring radiation exposure may contribute to the current deficiency in radiation awareness. Current dosimeters involve a considerable lag from the time that the surgical team is exposed to radiation to the time that they are provided with that exposure data. The objective of the current study was to assess the feasibility of monitoring radiation exposure in operating room personnel during lateral transpsoas lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) procedures by using a wearable personal device with real-time feedback.METHODSOperating room staff participating in minimally invasive surgical procedures under a single surgeon during a 6-month period were prospectively enrolled in this study. All radiation dose exposures were recorded for each member of the surgical team (surgeon, assistant surgeon, scrub nurse, and circulating nurse) using a personal dosimeter (DoseAware). Radiation doses were recorded in microsieverts (μSv). Comparisons between groups were made using ANOVA with the Tukey post hoc test and Student t-test.RESULTSThirty-nine patients underwent interbody fusions: 25 underwent LLIF procedures (14 LLIF alone, 11 LLIF with percutaneous screw placement [PSP]) and 14 underwent MI-TLIF. For each operative scenario per spinal level, the surgeon experienced significantly higher (p < 0.035) average radiation exposure (LLIF: 167.9 μSv, LLIF+PSP: 424.2 μSv, MI-TLIF: 397.9 μSv) than other members of the team, followed by the assistant surgeon (LLIF: 149.7 μSv, LLIF+PSP: 242.3 μSv, MI-TLIF: 274.9 μSv). The scrub nurse (LLIF: 15.4 μSv, LLIF+PSP: 125.7 μSv, MI-TLIF: 183.0 μSv) and circulating nurse (LLIF: 1.2 μSv, LLIF+PSP: 9.2 μSv, MI-TLIF: 102.3 μSv) experienced significantly lower exposures. Radiation exposure was not correlated with the patient’s body mass index (p ≥ 0.233); however, it was positively correlated with increasing patient age (p ≤ 0.004).CONCLUSIONSReal-time monitoring of radiation exposure is currently feasible and shortens the time between exposure and the availability of information regarding that exposure. A shortened feedback loop that offers more reliable and immediate data would conceivably raise the level of concern for radiation exposure in spinal surgeries and could alter patterns of behavior, leading to decreased exposures. Further studies are ongoing to determine the effect of real-time dosimetry in spinal surgery.

scholarly journals Contralateral interhemispheric transfalcine approach to precuneal glioblastoma: fluorescein guided microsurgical resection and endoscopic microinspection tool

2022 ◽  
Vol 6 (1) ◽  
pp. V11
Keyword(s):  
Survival Benefit ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Link Type ◽  
Endoscopic Assistance ◽  
Microsurgical Resection ◽  
Areas Of Concern ◽  
Visualization Techniques ◽  
Intraoperative Visualization

Maximum safe resection remains a primary goal in the treatment of glioblastoma, with gross-total resection conveying additional survival benefit. Multiple intraoperative visualization techniques have been developed to improve the extent of resection. Herein, the authors describe the use of fluorescein and endoscopic assistance with a novel microinspection device in achieving a gross-total resection of a deep seated precuneal glioblastoma. An interhemispheric transfalcine approach was utilized and microsurgical resection was completed with fluorescein guidance. A 45° endoscope was then used to inspect the resection bed, and remaining areas of concern were then resected under endoscopic visualization. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21195

scholarly journals Proximal junctional kyphosis after pediatric angular kyphotic deformity correction: Are we missing something?

2021 ◽  
Vol 16 (1) ◽  
pp. 106
Author(s):  
AbhinandanReddy Mallepally ◽  
Rajat Mahajan ◽  
Nandan Marathe ◽  
Ankur Nanda ◽  
Tarush Rustagi ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Kyphotic Deformity ◽  
Proximal Junctional Kyphosis ◽  
Junctional Kyphosis

Small Computer System for Micrograph Analysis

1981 ◽  
Vol 39 ◽  
pp. 270-271
Author(s):  
J. F. Hainfeld ◽  
J. S. Wall
Keyword(s):  
Large Range ◽  
Small Computer ◽  
Black And White ◽  
Contour Maps ◽  
Points Of Interest ◽  
Computer Aided Analysis ◽  
Specialized Hardware ◽  
Additional Memory ◽  
Selection Of ◽  
Publication Quality

Cost reduction and availability of specialized hardware for image processing have made it reasonable to purchase a stand-alone interactive work station for computer aided analysis of micrographs. Some features of such a system are: 1) Ease of selection of points of interest on the micrograph. A cursor can be quickly positioned and coordinates entered with a switch. 2) The image can be nondestructively zoomed to a higher magnification for closer examination and roaming (panning) can be done around the picture. 3) Contrast and brightness of the picture can be varied over a very large range by changing the display look-up tables. 4) Marking items of interest can be done by drawing circles, vectors or alphanumerics on an additional memory plane so that the picture data remains intact. 5) Color pictures can easily be produced. Since the human eye can detect many more colors than gray levels, often a color encoded micrograph reveals many features not readily apparent with a black and white display. Colors can be used to construct contour maps of objects of interest. 6) Publication quality prints can easily be produced by taking pictures with a standard camera of the T.V. monitor screen.

Spherulite Structures in a Melt Spun Fe-Ni Austenitic Steel

1985 ◽  
Vol 43 ◽  
pp. 52-53
Author(s):  
G. M. Michal ◽  
T. K. Glasgow ◽  
T. J. Moore
Keyword(s):  
Austenitic Steel ◽  
Room Temperature ◽  
Elevated Temperatures ◽  
Large Range ◽  
Amorphous Structure ◽  
Nucleation And Growth ◽  
Ni Alloys ◽  
Melt Spun ◽  
Crystal Fibers ◽  
Rapidly Solidified

Large additions of B to Fe-Ni alloys can lead to the formation of an amorphous structure, if the alloy is rapidly cooled from the liquid state to room temperature. Isothermal aging of such structures at elevated temperatures causes crystallization to occur. Commonly such crystallization pro ceeds by the nucleation and growth of spherulites which are spherical crystalline bodies of radiating crystal fibers. Spherulite features were found in the present study in a rapidly solidified alloy that was fully crysstalline as-cast. This alloy was part of a program to develop an austenitic steel for elevated temperature applications by strengthening it with TiB2. The alloy contained a relatively large percentage of B, not to induce an amorphous structure, but only as a consequence of trying to obtain a large volume fracture of TiB2 in the completely processed alloy. The observation of spherulitic features in this alloy is described herein. Utilization of the large range of useful magnifications obtainable in a modern TEM, when a suitably thinned foil is available, was a key element in this analysis.

Sign in / Sign up

Export Citation Format

Share Document