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

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.

Endodontic anatomy of lower premolars in a subpopulation from the Mureş county.

Background/Aim: Thorough knowledge of the endodontic anatomy and comprehensive understanding of root canal morphological variations are mandatory to ensure the successful outcome of the endodontic treatment. The purpose of this study was to compare the number of root canals of first and second lower premolars in a selected population to the root canal pattern reported by endodontic literature and to analyze the gender distribution. Material and methods: A total of 376 preoperative periapical radiographs were obtained from patients living in the Mureş County of Romania. The X-rays were analyzed by 3 endodontists into determining whether the mandibular premolars had one, two or three root canals. The difference between male and female gender distribution was also examined. Endodontic treatment was then performed using the operating microscope to confirm the root canal configuration of the radiographic analysis. The results were compared to common knowledge of the endodontic literature. Results: In this study, by using the radiographic method combined with direct observation aided by the operating microscope, 31.3% of first premolars and 14.6% of second premolars were found to have two root canals. A higher percentage of two root canals were found in females for both first (60.97%) and second premolars (76.9%). Conclusion: In the Mureş County region, mandibular premolars with two root canals have a significantly higher rate than the literature reports. Female patients have a higher prevalence than male patients. This should concern clinicians from this area to be aware of these facts as it can unquestionably influence the tooth’s long-term prognosis.

The outcome of direct composite restorations using the dental operating microscope

Background. The objective of the present study was to compare the outcome of direct composite restorations, with and without the use of additional magnification. Methods. Twenty extracted molars were selected for the study. Class 1 Black cavities were prepared. All teeth were etched, and bonding agent was applied. Teeth were assigned randomly into two groups of ten each. Group I: restorations were done without the use of magnification, first by placing a layer of SDR® flow +Bulk Fill Flowable on the base of the cavity, and then restoring the morphology with Ceram.X SphereTEC® One. Group II: the same protocol was applied, but using the dental microscope. Teeth were then evaluated before and after the finishing protocol by 5 dental professionals using a series of established criteria. The results were documented and statistically analyzed using the non-parametric Mann-Whitney test. Results. Statistically significant differences were found when using magnification, before the polishing protocol in “marginal adaptation integrity” and “excess material”, and after polishing in “marginal adaptation integrity”. Conclusions. Magnification may be used to increase the quality of the final direct posterior restoration by improving the marginal adaptation integrity, reducing excess material, preventing marginal microleakage, and avoiding subsequent failure.

Redosing of Fluorescein Sodium Improves Image Interpretation During Intraoperative Ex Vivo Confocal Laser Endomicroscopy of Brain Tumors

BackgroundFluorescein sodium (FNa) is a fluorescence agent used with a wide-field operating microscope for intraoperative guidance and with confocal laser endomicroscopy (CLE) to evaluate brain tissue. Susceptibility of FNa to degradation over time may affect CLE image quality during prolonged surgeries. This study describes improved characteristics of CLE images after intraoperative redosing with FNa.MethodsA retrospective analysis was performed using CLE images obtained ex vivo from samples obtained during tumor resections with FNa-based fluorescence guidance with a wide-field operating microscope. The comparison groups included CLE images acquired after FNa redosing (redose imaging group), images from the same patients acquired after the initial FNa dose (initial-dose imaging group), and images from patients in whom redosing was not used (single-dose imaging group). A detailed assessment of image quality and interpretation regarding different FNa dosage and timing of imaging after FNa administration was conducted for all comparison groups.ResultsThe brightest and most contrasting images were observed in the redose group compared to the initial-dose and single-dose groups (P<0.001). The decay of FNa signal negatively correlated with brightness (rho = -0.52, P<0.001) and contrast (rho = -0.57, P<0.001). Different doses of FNa did not significantly affect the brightness (P=0.15) or contrast (P=0.09) in CLE images. As the mean timing of imaging increased, the percentage of accurately diagnosed images decreased (P=0.03).ConclusionsThe decay of the FNa signal is directly associated with image brightness and contrast. The qualitative interpretation scores of images were highest for the FNa redose imaging group. Redosing with FNa to improve the utility of CLE imaging should be considered a safe and beneficial strategy during prolonged surgeries.

180 Improving Wall Access When Using Double Clamps for Microsurgical Anastomosis – A New Technique

Microvascular techniques and instrumentation have continually evolved since the advent of clinical microsurgery in the 1970’s. These refinements and improved patient selection have led to increased vessel patency and flap survival rates. However, a fundamental principle which has not changed over this time period is comfort and proper operating microscope set-up. Both these factors were described as a precondition of microsurgical success by the late pioneer of microsurgery himself, Robert Acland. Suboptimal comfort or set-up can negatively impact on access to the surgical field leading to improper technique and if significant enough, anastomotic thrombosis. We describe a new technique aimed at improving wall access when using double clamps for microsurgical anastomosis.

424 Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training for Theatre Nurses

Aim Shared mental models between surgeons and scrub nurses allow them to effectively communicate with each other and react efficiently to intraoperative complications. Microsurgery poses unique challenges including the use of an operating microscope, fine instruments, and restricted views of the operative field. Our aim was to design and deliver a microsurgical skills session for theatre nurses and evaluate whether attendance influenced perceived understanding of microsurgery and ability in day-to-day role. Method A microsurgical training day for theatre nurses was delivered. This consisted of an introduction to and positioning of the operating microscope and three practical stations involving increasingly complex motor tasks, designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub nurses to add an element of role-reversal. Qualitative and quantitative feedback was collected. Results Eight theatre nurses participated, all responded ‘strongly agree’ or ‘agree’ that the training was enjoyable, improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees strongly agreed that they would partake in similar sessions in the future. Conclusions Role-reversal and skills-based training is a valuable tool in improving multidisciplinary collaboration in microsurgery. Increasing shared knowledge of complex procedures prospers effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step towards development of a standardized microsurgical skills course for theatre nurses and has broader implications for interprofessional education across all surgical specialties.