Technique description: Incisionless ultrasound-assisted biceps tenotomy in dogs

Background: Bicipital tendinitis and/or tendinopathy is a common cause of forelimb lameness in dogs, particularly in larger and more active patients. Although conservative treatment aimed at resolving discomfort and preserving the tendon remains the primary therapeutic goal, in certain cases it is necessary to surgically transect the tendon to eliminate pain and lameness. Transection of the tendon can be performed by open arthrotomy, arthroscopically, or percutaneously using a scalpel blade. This paper examines the utility of a modified percutaneous approach using ahypodermic needle in place of a scalpel blade, under ultrasound-guided assistance.Aim: To develop and describe a surgical technique for performing a percutaneous biceps tenotomy using a hypodermic needle under ultrasound guidance Method: The technique was piloted using the shoulders of 12 cadaver dogs initially and once developed, then applied to another 12 cadavers. The final procedure was performed on a total of 22 shoulders. Assessments were recorded on time to complete the procedure, completeness of bicipital tendon transection, and presence of any iatrogenic damage to associated joint structures. Results: Procedure time averaged fewer than 2 minutes. Complete transection was achieved in 20 out of 22 of the shoulders, with evidence of incomplete transection discernable by ultrasound imaging in the remaining two shoulders. One cadaver shoulder experienced iatrogenic damage secondary to incorrect hypodermic needle angulation. Conclusion: Percutaneous biceps tenotomy using a hypodermic needle is an efficient and straightforward procedure. The lack of a surgical incision makes it the least invasive technique devised so far. Ultrasound imaging allows thepractitioner to assess the completeness of the transection increasing precision.

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The Control of Bloodloss During Percutanerous Nephrolithotomy Using Tranexamic Acid

Revista de Chimie ◽

10.37358/rc.18.10.6612 ◽

2018 ◽

Vol 69 (10) ◽

pp. 2728-2730

Author(s):

Raluca Costina Barbilian ◽

Victor Cauni ◽

Bogdan Mihai ◽

Ioana Buraga ◽

Mihai Dragutescu ◽

...

Keyword(s):

Tranexamic Acid ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Postoperative Bleeding ◽

Invasive Technique ◽

Transfusion Rate ◽

Renal Lithiasis ◽

Percutaneous Approach ◽

Transfusion Requirements ◽

Urinary Sepsis

The aim of this study is to assess the efficiency and safety of the tranexamic acid in reducing hemmorrhagic complications and transfusion requirements in patients with renal lithiasis treated by percutaneous approach. Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique used for large kidney stones (]20mm). Urinary sepsis and intra or postoperative bleeding are the very serious complications associated with this type of procedure. Tranexamic acid is used in the treatment of many haemorrhagic conditions. The experience with tranexamic acid in preventing bloodloss during percutaneous nephrolithotomy is very limited. The use tranexamic acid in percutaneous nephrolithotomy is safe and is associated with reduced blood loss and a lower transfusion rate.

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S123 – New Approaches to Infratemporal Fossa Foreign Body Removal

Otolaryngology ◽

10.1016/j.otohns.2008.05.296 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P118-P118

Author(s):

Andrew R Scott ◽

Thomas B Dodson ◽

Michael P Platt ◽

Ralph B Metson

Keyword(s):

Minimally Invasive ◽

Head And Neck ◽

Foreign Bodies ◽

Infratemporal Fossa ◽

Tertiary Care ◽

Care Facility ◽

Guidance System ◽

Invasive Technique ◽

Hypodermic Needle ◽

Surgical Removal

Objectives 1) To understand indications for removal of foreign bodies (FB) from the head and neck. 2) To be able to describe the use of new surgical technologies for FB removal from the head and neck region. 3) To understand the clinical applications of a novel, minimally-invasive technique for removal of FB from the infratemporal fossa. Methods A retrospective review of 2 cases of infratemporal fossa foreign bodies, which were referred to a tertiary care facility for management utilizing a novel transoral, endoscopic, image-guided approach. Results Both patients presented with pain and trismus following failed attempts to retrieve foreign bodies–1 broken hypodermic needle and 1 torn cottonoid sponge-through open explorations. Use of endoscopic equipment for visualization and image-guidance system for precise localization enabled both objects to be removed through a transoral approach. Surgical removal resulted in improvement in pain and trismus in both patients who were discharged within 24 hours. Conclusions A new approach is now available for the minimally-invasive retrieval of radio-opaque foreign bodies in the infratemporal fossa, which avoids the need for extensive surgical dissection or an external incision.

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Endoscopic treatment for complex biliary and pancreatic duct injuries

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.141926 ◽

2014 ◽

Vol 05 (01) ◽

pp. 002-012 ◽

Cited By ~ 1

Author(s):

Simon Bouchard ◽

Jacques Devière

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Percutaneous Treatment ◽

Severe Form ◽

Pancreatic Ducts ◽

Severe Injuries ◽

Percutaneous Approach ◽

The Past ◽

Bile Duct Injuries ◽

Complete Transection

AbstractSevere injuries of biliary or pancreatic ducts are associated with significant morbidity and mortality. Severe bile duct injuries such as major biliary leaks, complete transection, or complete occlusion of bile ducts can be grouped under the term complex bile duct injuries (CBDI). In the spectrum of pancreatic duct injuries, disconnected pancreatic duct syndrome (DPDS) represents the most severe form and most often occurs after a severe episode of acute pancreatitis. Treatment of these complex injuries is quite challenging and for many years surgical management has been considered the treatment of choice. However, in the past few years, some studies have reported the successful management of CBDI or DPDS using endoscopic procedures alone or in combination with a percutaneous approach. In this review, we detail the endoscopic or combined endoscopic/percutaneous treatment possibilities for CBDI and DPDS.

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An Anatomic Study of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy Technique to Correct Hindfoot Malalignment

Foot & Ankle International ◽

10.1177/1071100716674259 ◽

2016 ◽

Vol 38 (2) ◽

pp. 192-199 ◽

Cited By ~ 7

Author(s):

Andrea Veljkovic ◽

Joshua Tennant ◽

Chamnanni Rungprai ◽

Kaniza Zahra Abbas ◽

Phinit Phisitkul

Keyword(s):

Minimally Invasive ◽

Open Surgery ◽

Invasive Technique ◽

Surgical Incision ◽

Calcaneal Osteotomy ◽

Osteotomy Technique ◽

Fresh Frozen ◽

Wound Healing Problems ◽

Potential Risks ◽

Invasive Techniques

Background: Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. Methods: Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach. Results: Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery. Conclusions: Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery. Clinical Relevance: Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.

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Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract

Canadian Urological Association Journal ◽

10.5489/cuaj.1699 ◽

2014 ◽

Vol 8 (5-6) ◽

pp. 366 ◽

Cited By ~ 1

Author(s):

Alvaro Juarez-Soto ◽

Jose Miguel Arroyo-Maestre ◽

Manuel Soto-Delgado ◽

Pastora Beardo-Villar ◽

Miguel Angel Arrabal-Polo ◽

...

Keyword(s):

Laparoscopic Hysterectomy ◽

Muscle Layer ◽

Ureteral Injury ◽

Complete Resection ◽

Invasive Technique ◽

Distal Stump ◽

Distal Ureter ◽

Complete Transection ◽

Repair Procedure ◽

Unilateral Injury

We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.

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Minimally invasive technique for intrathecal administration of morphine in rats: practicality and antinociceptive properties

Laboratory Animals ◽

10.1177/0023677216682771 ◽

2016 ◽

Vol 51 (5) ◽

pp. 479-489

Author(s):

Aurelie Anic Thomas ◽

Johann Detilleux ◽

Charlotte Friederike Sandersen ◽

Paul Andrew Flecknell

Keyword(s):

Minimally Invasive ◽

Technical Difficulty ◽

Intrathecal Administration ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Hypodermic Needle ◽

Direct Puncture ◽

Anaesthetized Rats ◽

Potential Interactions ◽

To Receive

The intrathecal (IT) route of administration represents a means to reduce the dose of morphine administered for analgesia, potentially minimizing interactions between opioid effects and experimental outcomes. Perceived technical difficulty, and previously described invasive methods, may limit its use. This report describes a minimally invasive technique for IT administration of morphine by direct transcutaneous lumbosacral puncture in rats; and assesses antinociceptive properties of morphine in anaesthetized rats. Rats ( n = 28) anaesthetized with sevoflurane (inspired fraction of sevoflurane: FiSevo = 2.4%) were randomly allocated to receive: IT morphine (0.2 mg/kg); subcutaneous (SC) morphine (3 mg/kg); SC buprenorphine (0.05 mg/kg); or SC or IT sodium chloride (NaCl). After a wash-in period (40 min), thermal nociceptive stimuli were applied at nine locations corresponding to different rostrocaudal dermatomes of the rat. Nociceptive stimulation cycles were repeated at all locations after successive decrement of FiSevo by 15%. Presence or absence of gross purposeful movement (GPM) was recorded for each individual stimulation. IT injection of morphine by direct puncture with a 25 G hypodermic needle is easily performed (successful first attempt: 82%) without complications. IT morphine reduced the frequency of GPM following nociceptive thermal stimulation in a way comparable with SC buprenorphine or morphine. It was not possible to delimit any rostral spinal spread of morphine. This report describes a refined and effective technique of administering morphine IT in rats using readily available materials. IT doses being markedly smaller than the systemic equivalent, analgesia could be provided whilst minimizing the potential interactions of non-analgesic opioid effects with research protocols.

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Elast PQ Ultrasound - a Noninvasive, Reproducible, Easily Performed Method and a New Era in Liver Fibrosis Assessment

Faridpur Medical College Journal ◽

10.3329/fmcj.v13i1.38019 ◽

2018 ◽

Vol 13 (1) ◽

pp. 44-46

Author(s):

Hafizur Rahman

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Biopsy ◽

Viral Hepatitis ◽

Ultrasound Imaging ◽

Liver Diseases ◽

Chronic Liver ◽

Invasive Technique ◽

Liver Imaging ◽

Chronic Liver Diseases

Liver fibrosis represents the repair mechanism in liver injury and is a feature of most chronic liver diseases. The degree of liver fibrosis in chronic viral hepatitis infection has major clinical implications and presence of advanced fibrosis or cirrhosis determines prognosis. Treatment initiation for viral hepatitis is indicated in most cases of advanced liver fibrosis and diagnosis of cirrhosis entails hepatology evaluation for specialized clinical care. Liver biopsy is an invasive technique and has been the standard of care of fibrosis assessment for years; however, it has several limitations and procedure related complications. Recently, several methods of noninvasive assessment of liver fibrosis have been developed which require either serologic testing or imaging of liver. Imaging based noninvasive techniques are reviewed here and their clinical use is described. Some of the imaging based tests are becoming widely available, and collectively they are shown to be superior to liver biopsy in important aspects. Clinical utilization of these methods requires understanding of performance and quality related parameters which can affect the results and provide wrong assessment of the extent of liver fibrosis. Familiarity with the strengths and weakness of each modality is needed to correctly interpret the results in appropriate clinical content. A new technique called Elast PQ uses ultrasound shear wave elastography to provide a noninvasive, reproducible, easily performed method of assessing liver fibrosis. It can easily combine a routine ultrasound imaging exam of the liver anatomy with targeted tissue stiffness values, assess liver fibrosis in patient with clinically suspected disease even before abnormalities are detected with ultrasound imaging, evaluate and obtain a baseline stiffness value in patients with chronic liver disease, follow up patients under treatment to monitor progression, stabilization or regression of liver disease and help avoid the need for liver biopsies when elastography results are consistent with other clinical findings. Both the prognosis and potential treatment of chronic liver diseases greatly depend on the progression of liver fibrosis, which is the ultimate outcome of chronic liver damage. Historically, liver biopsy has been instrumental in adequately assessing patients allows clinicians both to obtain diagnosis information and initiate adequate therapy. However, the technique is not exempt of deleterious effects. Multiple diagnostic tests have been developed for the staging of fibrosis using noninvasive methods, most of them in the setting of chronic hepatitis C. The goal of this paper is to review available data on the staging and assessment of liver fibrosis with two methods: serum markers & transient elastography (FibroScan).Faridpur Med. Coll. J. Jan 2018;13(1): 44-46

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A Proposed Approach to De-speckle an Ultrasound Image using Anisotropic Filter by Generating Diffusion Tensor

International Journal of Current Engineering and Technology ◽

10.14741/ijcet/v.8.3.29 ◽

2018 ◽

Vol 8 (3) ◽

Author(s):

Poonam Chauhan ◽

Vikas Kaushik

Keyword(s):

Ultrasound Imaging ◽

Diffusion Tensor ◽

Signal To Noise Ratio ◽

Ultrasound Image ◽

Similarity Index ◽

Speckle Noise ◽

The Body ◽

Invasive Technique ◽

Signal To Noise ◽

Noise Ratio

Ultrasound imaging is a technique that is used to diagnose the diseases in medical field using radiology. US (ultrasound) imaging is a non -invasive technique and used for imaging of internal structure of the body without any kind of penetration which helps to identify the diseases that have probability and tissues. Many kinds of noises present in US images but the presence of speckle noise is a big challenge since last few years in biomedical field. Sometimes speckle noise becomes the part of information and vice-versa. So it becomes hard to find the disease for doctors. There are many de-speckled filters available for de-noising. This paper gives a proposed approach to de-speckled the US image using anisotropic diffusion filter by calculating the different numerical values like SSIM (structural similarity index), SNR (signal to noise ratio), MSE (mean square error), PSNR (peak signal to noise ratio), which results in coherence enhancement The proposed technique provides better and improved edge and coherence enhancement in ultrasound image data.

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The Re-Emergence of Percutaneous Fasciotomy in the Management of Dupuytren’s Disease

The Open Orthopaedics Journal ◽

10.2174/1874325001206010083 ◽

2012 ◽

Vol 6 (1) ◽

pp. 83-87 ◽

Cited By ~ 4

Author(s):

James Donaldson ◽

Nicholas Goddard

Keyword(s):

Deformity Correction ◽

Dupuytren’S Disease ◽

Hypodermic Needle ◽

Published Data ◽

Simple Method ◽

Dupuytren's Disease ◽

Second Stage ◽

Scalpel Blade ◽

Invasive Techniques

Dupuytren’s disease is a common condition. Its management has gradually evolved but still remains a source of much controversy. Recently there has been a resurgence in the popularity of percutaneous needle fasciotomy. It is a simple method that uses a hypodermic needle as a scalpel blade. It is usually performed in the out-patient setting under local anaesthesia without a tourniquet. It has few complications and allows almost immediate return to work with few restrictions. It can provide complete deformity correction and may offer a long-term solution in selected patients. It is also useful in converting advanced contractures into milder deformities, allowing a second stage digito-palmar fasciectomy to be more successful. Recurrence is earlier than with more formal and invasive techniques but the procedure can be repeated and does not preclude the patient from further surgery. This article reviews the technique and assesses the efficacy and outcomes of published data.

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(in vivo Gastrocnemius Muscle) Tendon Ratio in Patients with Cerebral Palsy

The Open Orthopaedics Journal ◽

10.2174/1874325001711010577 ◽

2017 ◽

Vol 11 (1) ◽

pp. 577-582

Author(s):

Muhammad Naghman Choudhry ◽

Haris Naseem ◽

Ihsan Mahmood ◽

Adeel Aqil ◽

Tahir Khan

Keyword(s):

Cerebral Palsy ◽

Gastrocnemius Muscle ◽

Muscle Length ◽

Leg Length ◽

Normal Children ◽

Surgical Incision ◽

Average Percentage ◽

Surgical Access ◽

Iatrogenic Damage

Background: The position of the gastrocnemius tendon in relation to the leg length may be different in children with cerebral palsy as compared to normal children. The palpation of muscle bellies or previous experience of the operating surgeon is employed to place the surgical incision for lengthening of the gastrocnemius aponeurosis. Inaccurate localisation may cause incorrect incisions and a risk of iatrogenic damage to the vital structures (i.e. sural nerve). Objectives: The aim of our study is to compare gastrocnemius length in-vivo between paretic and unaffected children and create a formula to localise the muscle–tendon junction accurately. Methods: 10 children with di/hemiplegia (range 2-14y) were recruited. None of them had received any conventional medical treatment. An equal number of age/sex matched, typically developing children (range 4-14y) were recruited. Ultrasound scanning of the gastrocnemius muscle at rest was performed to measure the length of gastrocnemius bellies. We also measured the heights and leg lengths in all the children. Results: The gastrocnemius medial muscles were shorter in Cerebral Palsy children when compared to similar aged normal children. In cerebral palsy children, the gastrocnemius muscle and leg ratio ranged between 35 to 50% (average ratio of 45%). Conclusion: Using these figures, we created an average percentage for gastrocnemius muscle length that may be used clinically to identify the tendon for open/endoscopic lengthening and also to make simple and accurate localisation of gastrocnemius muscle-tendon junction for surgical access. This decreases the length of the surgical incision and may reduce the risk of iatrogenic injuries.

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