Academic literature on the topic 'Surgical Procedures, Operative'
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Journal articles on the topic "Surgical Procedures, Operative"
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Staudt, Amanda M., Mithun R. Suresh, Jennifer M. Gurney, Jennifer D. Trevino, Krystal K. Valdez-Delgado, Christopher A. VanFosson, Frank K. Butler, Elizabeth A. Mann-Salinas, and Russ S. Kotwal. "Forward Surgical Team Procedural Burden and Non-operative Interventions by the U.S. Military Trauma System in Afghanistan, 2008–2014." Military Medicine 185, no. 5-6 (December 20, 2019): e759-e767. http://dx.doi.org/10.1093/milmed/usz402.
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Abstract Introduction No published study has reported non-surgical interventions performed by forward surgical teams, and there are no current surgical benchmarks for forward surgical teams. The objective of the study was to describe operative procedures and non-operative interventions received by battlefield casualties and determine the operative procedural burden on the trauma system. Methods This was a retrospective analysis of data from the Joint Trauma System Forward Surgical Team Database using battle and non-battle injured casualties treated in Afghanistan from 2008–2014. Overall procedure frequency, mortality outcome, and survivor morbidity outcome were calculated using operating room procedure codes grouped by the Healthcare Cost and Utilization Project classification. Cumulative attributable burden of procedures was calculated by frequency, mortality, and morbidity. Morbidity and mortality burden were used to rank procedures. Results The study population was comprised of 10,992 casualties, primarily male (97.8%), with a median age interquartile range of 25.0 (22.0–30.0). Affiliations were non-U.S. military (40.0%), U.S. military (35.1%), and others (25.0%). Injuries were penetrating (65.2%), blunt (32.8), and burns (2.0%). Casualties included 4.4% who died and 14.9% who lived but had notable morbidity findings. After ranking by contribution to trauma system morbidity and mortality burden, the top 10 of 32 procedure groups accounted for 74.4% of operative care, 77.9% of mortality, and 73.1% of unexpected morbidity findings. These procedure groups included laparotomy, vascular procedures, thoracotomy, debridement, lower and upper gastrointestinal procedures, amputation, and therapeutic procedures on muscles and upper and lower extremity bones. Most common non-operative interventions included X-ray, ultrasound, wound care, catheterization, and intubation. Conclusions Forward surgical team training and performance improvement metrics should focus on optimizing commonly performed operative procedures and non-operative interventions. Operative procedures that were commonly performed, and those associated with higher rates of morbidity and mortality, can set surgical benchmarks and outline training and skillsets needed by forward surgical teams.
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Coughlan, Fionn, Prasad Ellanti, Cliodhna Ní Fhoghlu, Andrew Moriarity, and Niall Hogan. "Audit of Orthopaedic Surgical Documentation." Surgery Research and Practice 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/782720.
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Introduction. The Royal College of Surgeons in England published guidelines in 2008 outlining the information that should be documented at each surgery. St. James’s Hospital uses a standard operation sheet for all surgical procedures and these were examined to assess documentation standards.Objectives. To retrospectively audit the hand written orthopaedic operative notes according to established guidelines.Methods. A total of 63 operation notes over seven months were audited in terms of date and time of surgery, surgeon, procedure, elective or emergency indication, operative diagnosis, incision details, signature, closure details, tourniquet time, postop instructions, complications, prosthesis, and serial numbers.Results. A consultant performed 71.4% of procedures; however, 85.7% of the operative notes were written by the registrar. The date and time of surgery, name of surgeon, procedure name, and signature were documented in all cases. The operative diagnosis and postoperative instructions were frequently not documented in the designated location. Incision details were included in 81.7% and prosthesis details in only 30% while the tourniquet time was not documented in any.Conclusion. Completion and documentation of operative procedures were excellent in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions.
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Malek, Kirollos S., Jukes P. Namm, Carlos A. Garberoglio, Maheswari Senthil, Naveen Solomon, Mark E. Reeves, and Sharon S. Lum. "Attending Surgeon Variation in Operative Case Length: An Opportunity for Quality Improvement." American Surgeon 84, no. 10 (October 2018): 1595–99. http://dx.doi.org/10.1177/000313481808401011.
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Balancing resident education with operating room (OR) efficiency, while accommodating different styles of surgical educators and learners, is a challenging task. We sought to evaluate variability in operative time for breast surgery cases. Accreditation Council for Graduate Medical Education case logs of breast operations from 2011 to 2017 for current surgical residents at Loma Linda University were correlated with patient records. The main outcome measure was operative time. Breast cases were assessed as these operations are performed during all postgraduate years (PGY). Breast procedures were grouped according to similarity. Variables analyzed included attending surgeon, PGY level, procedure type, month of operation, and American Society of Anesthesiologists class. Of 606 breast cases reviewed, median overall operative time was 150 minutes (interquartile range 187–927). One-way analysis of covariance demonstrated statistically significant variation in operative time by attending surgeon controlling for covariates (PGY level, procedure, American Society of Anesthesiologists class, and month) ( P = 0.04). With institutional OR costs of $30 per minute, the average difference between slowest and fastest surgeon was $2400 per case [(218–138) minutes 3 $30/min]. Minimizing variability for common procedures performed by surgical educators may enhance OR efficiency. However, the impact of case length on surgical resident training requires careful consideration.
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Afuwape, Oludolapo, and Ikechukwu Bartholomew Ulasi. "Evaluation of surgical Apgar score as a predictor of postoperative complications in emergency general surgical patients in a Nigerian teaching hospital." Edorium Journal of Surgery 9, no. 2 (May 17, 2022): 1–8. http://dx.doi.org/10.5348/100057s05oa2022ra.
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Aims: The aim of this study was to evaluate the ability of the surgical Apgar score (SAS) to predict post-operative complications at the University College Hospital (UCH), Ibadan, Nigeria. Methods: This was a retrospective study of adult patients undergoing emergency general surgery procedures. The main end-points were post-operative mortality and surgical site infection (SSI). The ability of the SAS to predict post-operative outcomes was determined using the receiver operating characteristics curve (ROC). Statistical significance was defined by a p value of less than 0.05. Results: The mean SAS was 5.6 ± 1.7 with majority of patients (61.4%, n = 70) being at medium risk (Apgar score 5–7) for post-operative complication. The most common post-operative complication was SSI (47.1%, n = 25) with a 30-day mortality of 9.6%. The ROC curve showed that the SAS is a poor predictor of post-operative complications (Area under the curve [AUC] = 0.408) and mortality (AUC = 0.394). However, there is a statistically significant association between mean SAS and occurrence of post-operative complications (p = 0.026). Conclusion: The SAS does not predict post-operative complications in adult patients undergoing emergency general surgery procedures.
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Jakovljevic, Branislava, Dimitrije Segedi, and Hajrija Mujovic-Zornic. "Medico-legal aspects of hysterectomy." Medical review 60, no. 5-6 (2007): 251–54. http://dx.doi.org/10.2298/mpns0706251j.
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Introduction: Understanding the lawful implementations of surgical procedures, such as hysterectomy, raises practical questions concerning legal relations between a doctor and his patient, and consequences of this relationship, which may be legally relevant. The modern legal theory and practice consider doctors and patients to be partners. Consent and Information: Medical practitioners performing surgical procedures are obliged to obtain informed consent. They are also required to inform their patients about indications, course of the operative procedure, postoperative treatment, possible complications during and after the procedure, and quality of life after the operation. Informed conversation should take into account the age, mental status and patient's intellectual abilities. Legal consequences of surgical procedures Malpractice litigation mostly concers medical error and negligence. Medical errors should not be confused with ineffective outcome, or complicated postoperative course. Even if the surgical procedure was followed correctly and uneventful outcome took place, there might be some problems. Conclusion: A patient has a right to receive complete information from a physician about the specific nature of a proposed treatment. A physician has an obligation to elucidate and justify treatment he proposes. Certain codification of all operative procedures may facilitate this task. Codification instructions about procedures, in this case hysterectomy, must include indications for a certain type of hysterectomy (subtotal, total, radical), as well as for the operative technique (abdominal, vaginal, laparoscopic). Patient information brochures should be available in print, and include information about indications and potential risks associated with the proposed surgical procedure. In this way, it is possible to prevent the inconveniencies which may arise from insufficient knowledge and information about surgical procedures.
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MacHi, Junji, Bernard Sigel, Toshihiko Kurohiji, Howard A. Zaren, and Joaquin Sariego. "Operative ultrasound guidance for various surgical procedures." Ultrasound in Medicine & Biology 16, no. 1 (January 1990): 37–42. http://dx.doi.org/10.1016/0301-5629(90)90084-p.
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Nakano, Hiroshi. "Training of Operative Procedures with Surgical Illustrations." Japanese Journal of Neurosurgery 29, no. 1 (2020): 45–48. http://dx.doi.org/10.7887/jcns.29.45.
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Chaudhary, Sanjay, Lokeshwar Chaurasia, and Jitendra Kumar Singh. "Duration of Hospital Stay and Treatment Pattern among Patients Undergoing Common Operative Procedures at tertiary care hospital in Nepal." Janaki Medical College Journal of Medical Science 7, no. 2 (December 31, 2019): 27–35. http://dx.doi.org/10.3126/jmcjms.v7i2.30691.
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Background and Objectives: Appendectomy, cholecystectomy, fistulectomy, and herniotomy or herniorrhaphy are the most common surgical operations in Nepal. Despite the high prevalence and complexity of the patient population served by general and universal surgery services, little has been reported about the services, treatment procedures and outcomes. Therefore, the study is designed to investigate the duration of hospital stay, and treatment pattern among patients undergoing common surgical operative procedures at Janaki Medical College, Janakpur, Nepal.
Material and methods: A prospective observational study was conducted among patients undergoing common surgical operative procedures at surgery department of Janaki Medical College (JMC) over a period of one year from January 2018 to December 2018. Patients of all age groups and gender undergoing surgical operative procedures; appendectomy, herniotomy cholecystectomy and fistulectomy were included in the study. The patients were assessed preoperatively, intra-operatively and postoperatively.
Results: In a total of 325 patients, 11.1% of patients underwent fistulectomy, 14.5% underwent appendectomy, 35.4% underwent herniorrhaphy and 39.1% underwent cholecystectomy. Mean duration of stay at hospital for cholecystectomy was slightly higher (8.13±2.40 days) than other operating procedures: fistulectomy (5.44 ±1.48 days), appendectomy (7.40±2.00 days), and operative procedure of hernia (6.17±1.59 days). Most commonly used antibiotic for control of preoperative and post operative infection was third generation cephalosporin’s, ceftriaxone and cefixime.
Conclusion: The study demonstrates longer duration of hospital stay for cholecystectomy as compared to other operating procedures like fistulectomy, appendectomy, herniorrhaphy, hernioplasty and herniotomy with significant difference by types of surgery. Most commonly used antibiotic for control of infection was third generation cephalosporin, ceftriaxone and cefixime.
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Johnson, J. Patrick, Samuel S. Ahn, William C. Choi, Jeffery E. Masciopinto, Kee D. Kim, Aaron G. Filler, and Antonio A. F. DeSalles. "Thoracoscopic sympathectomy: techniques and outcomes." Neurosurgical Focus 4, no. 2 (February 1998): E6. http://dx.doi.org/10.3171/foc.1998.4.2.7.
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Thoracic sympathectomy is an important option in the treatment of palmar hyperhidrosis and pain disorders. Earlier surgical procedures were highly invasive with known morbidity, acceptable outcome, and established recurrence rates that were the limitations to considering surgical treatment. Thoracoscopic sympathectomy is a minimally invasive procedure that allows detailed visualization of the sympathetic ganglia and minimal postoperative morbidity; however, outcome studies of this technique have been limited. The authors treated 39 patients with 60 thoracoscopic procedures, and the outcomes in this small series were equivalent to previously established open surgical techniques; however, operative moribidity rates, hospital stay, and time of return to normal activity were substantially reduced. Complications and recurrence of symptoms were also comparable to previous reports. Overall patient satisfaction and willingness to repeat the operative procedure ranged from 66 to 96% in all patients. Patients and physicians can consider minimally invasive thoracoscopic sympathectomy procedures as an option to treat sympathetically mediated disorders because of the procedure's reduced morbidity and at least equivalent outcome rates in comparison to other treatments.
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Heywood, R. L., L. A. Cochrane, and B. E. J. Hartley. "Parotid duct ligation for treatment of drooling in children with neurological impairment." Journal of Laryngology & Otology 123, no. 9 (March 2, 2009): 997–1001. http://dx.doi.org/10.1017/s0022215109004733.
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AbstractObjective:Multiple surgical procedures have been advocated for the management of problematic drooling in neurologically impaired children. Parotid duct ligation is a quick and simple operation conducted via an intra-oral approach and usually performed simultaneously with other procedures. In this study, we aimed to evaluate the effectiveness of parotid duct ligation as a discrete procedure.Methods:All children who underwent bilateral parotid duct ligation as the solitary operative intervention at that time, between February 2003 and September 2006, were included in the study.Results:Ten children were studied. Surgery was successful in 80 per cent of cases. One patient (10 per cent) had a post-operative wound infection.Conclusions:Bilateral parotid duct ligation is an effective yet conservative operation for drooling in neurologically impaired children. It requires minimal surgical dissection and has a low morbidity rate. It should be considered as a potential first-line procedure in children who aspirate, and as a further surgical option in anterior droolers or those who continue to drool unacceptably following prior surgical intervention.
Dissertations / Theses on the topic "Surgical Procedures, Operative"
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Lou, Meei-Fang. "Cognitive disturbance among elderly Taiwanese patients after elective surgery /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/7360.
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Le, Vi T. H. "Accurate modelling and positioning of a magnetically-controlled catheter tip." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/1711.
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This thesis represents the initial phase of a proposed operator and patient friendly method designed to semi-automate the positioning and directing of an intravascular catheter in the human heart using a variable electromagnetically induced field to control a catheter tip equipped with three tiny fixed magnets oriented in XYZ planes. Here we demonstrate a comprehensive mathematical model which accurately calculates the magnetic field generated by the electromagnet system, and the magnetic torques and forces exerted on a three-magnet tip catheter. From this we have developed an iterative predictive computer algorithm to show the displacement and deflection of the catheter tip. Using an eight variable power electromagnet system around a 250mm sphere of air we have proven the ability of this to accurately move the catheter tip from an initial position to a designated position within the field.
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Cuming, Richard G. "Factors Surgical Team Members Perceive Influence Choices of Wearing or not Wearing Personal Protective Equipment During Operative/Invasive Procedures." FIU Digital Commons, 2009. http://digitalcommons.fiu.edu/etd/111.
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Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.
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Nordin, Pär. "Groin hernia surgery : studies on anaesthesia and surgical technique /." Linköping : Univ, 2003.
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Franco, Fernando Fabricio 1978. "Incidência de embolia gordurosa pós-cirurgia de lipoaspiração com ou sem lipoenxertia = estudo em animais." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313795.
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Orientadores: Alfio José Tincani, Luciana Rodrigues de MeirellesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A lipoaspiração é um procedimento cirúrgico que consiste na retirada do excesso de tecido gorduroso localizado, em indivíduos saudáveis. Este procedimento, que muito aumentou nas últimas décadas em todo o mundo, pode ser associado à lipoenxertia. Ambos são empregados para melhora do contorno corporal. Uma das principais complicações relacionadas com a lipoaspiração é a embolia gordurosa. O presente estudo tem por objetivo verificar qualitativamente se existe mobilização intravascular da gordura após lipoaspiração manual pela técnica de infiltração superúmida para pulmões, fígado, rins e cérebro, em ratos da raça Wistar, seguida ou não de lipoenxertia. Método: Utilizou-se 30 modelos animais de ratos da linhagem Wistar. Os animais foram submetidos ao método usual da lipoaspiração e analisados em três diferentes grupos. Todos os animais foram anestesiados e infiltrados no subcutâneo do abdome com soro fisiológico contendo adrenalina, distribuídos da seguinte forma: no grupo A, dez animais serviram de controle, no grupo B, 10 animais foram lipoaspirados na região abdominal e no grupo C outros 10 animais, além de lipoaspirados, foram lipoenxertados na região dorsal inferior. Uma amostra de sangue foi colhida logo após a anestesia e após 48h dos procedimentos em todos os grupos, para gota de esfregaço em lâmina. Esse procedimento analisou os valores da hemoglobina, bem como a oxigenação sanguínea. Todos os animais foram submetidos á eutanásia após 48h, e os pulmões, rins, fígado e cérebro analisados histologicamente por duas colorações diferentes: Hematoxilina e Eosina (H&E) e Sudan Negro. Resultado: Foram encontradas partículas de gordura nos pulmões de três animais do Grupo B que foram apenas lipoaspirados e, em seis animas do grupo C, lipoaspirados e lipoenxertados. Nos animais do grupo controle, não foram identificados à presença de partículas de gordura em nenhum órgão estudado. Conclusão: Este estudo demonstra que há risco de mobilização sistêmica de gordura, após lipoaspiração e este risco aumenta, quando o procedimento está associado à lipoenxertia, em ratos Wistar
Abstract: Introduction: Liposuction is a surgical procedure that consists of the removal of excess fatty tissue found in health subjects. This procedure, which has become increasingly common in recent decades throughout the world, can be associated with fat grafting. Both are employed to improve the body contour. One of the main complications of liposuction is fat embolism. The present study aims to verify whether there is qualitative intravascular mobilization of fat after the employment of the liposuction technique manual super wet infiltration of the lungs, liver, kidneys and brain in Wistar rats followed or not by fat grafting. Method: We used animal models of 30 Wistar rats. The animals were subjected to the usual method of liposuction and analyzed in three different groups. All animals were anesthetized and infiltrated with saline solution containing epinephrine, distributed as follows: Group A, ten animals served as controls, in group B, 10 animals were liposuction in the abdominal region in group C and 10 other animals, and liposuction were in the lower back fat grafting. A blood sample was collected immediately after anesthesia and 48h of procedures in all groups, to drop the smear slide and examine the values of hemoglobin, and blood oxygenation. All animals were euthanized after 48h, and the lungs, kidneys, liver and brains were histologically examined by two different colors: hematoxylin and eosin (H & E) and Sudan Black. Results: There were fat particles in the lungs of three animals in Group B that were only subject to liposuction and six animals in group C, subject to liposuction and fat grafting. Fat particles were not found in any organ studied in the control group. Conclusion: This study demonstrates that there is risk of systemic fat mobilization after liposuction and this risk increases when the procedure is associated with fat grafting in Wistar rats
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências
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Oliveira, Murielly Marques de. "Fadiga em pacientes submetidos à cirurgia oncológica: uma coorte prospectiva." Universidade Federal de Goiás, 2015. http://repositorio.bc.ufg.br/tede/handle/tede/5434.
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INTRODUCTION. Fatigue in patients undergoing cancer surgery is frequent and brings negative repercussions for the operated individual. There are many knowledge gaps about this multidimensional experience and the factors involved in its occurrence and intensity. OBJECTIVE. Evaluate the fatigue of patients undergoing cancer surgery. METHOD. It is an open prospective cohort, with an initial sample of 117 patients (mean age = 51.2 years; 76.9% female; 65.8% lived with a partner, 58.1% brown skin color; 90.6% non-smoking; 70.9% did not undergo neoadjuvant treatment). They were evaluated between 36 and 02 hours before surgery (baseline - T1), and in two follow-ups: (T2) between 12 and 48 hours after surgery and (T3)10days ± 2 days after surgery. After approval by the ethics committees in research of the study sites and informed consent, patients answered the Piper Fatigue Scale-Revised, Perceived Stress Scale, Adaptive Capacity Index, Hospital Anxiety and Depression Scale, Numerical Pain and Sleep Scales; Karnofsky Performance Scale (KPS). RESULTS. The prevalence of fatigue among patients in the preoperative period of surgical oncology was 25.6% (n = 30). Preoperative fatigue was associated with anxiety, depression, stress, sleep disturbance, pain and worse performance status. Of all the instruments applied, KPS showed better characteristics related to accuracy for assessment of fatigue. The incidence of fatigue in T2 and T3 was 32.3% (n = 32) and 22.7% (n = 17), respectively. The average intensity of fatigue was moderate in all evaluations and the affective dimension had significantly higher scores than the other dimensions. Postoperatively, marital status and adaptive capacity were associated with fatigue in T3. Furthermore, it was observed that the adaptive capacity, sleep disturbance and performance status impacted the development of postoperative fatigue. CONCLUSIONS. This longitudinal study provided new evidence in the knowledge of postoperative fatigue, supporting the planning of more effective actions to prevent and treat fatigue and other symptoms. There was gradual reduction of the occurrence of fatigue after cancer surgery. The affective dimension of fatigue was the dimension with greater intensity. In the preoperative phase, emotional aspects (anxiety, depression and stress), pain, sleep and performance status were associated with fatigue, the latter being more important for accuracy. Postoperatively, those without a partner and worse adaptive capacity should be managed more rigorously since they have more fatigue than the other patients. In addition to these factors, sleep and performance status should be investigated since they impact on the evolution of fatigue.
INTRODUCCIÓN. La fatiga en pacientes sometidos a cirugía de cáncer es frecuente y trae consecuencias negativas para el individuo operado. Hay muchas lagunas en el conocimiento sobre esta experiencia multidimensional acerca de los factores que intervienen en su aparición e intensidad. OBJETIVO. Evaluar la fatiga de los pacientes sometidos a cirugía de cáncer. MÉTODO. Se trata de una cohorte prospectivo abierto, con una muestra inicial de 117 pacientes (edad media = 51,2 años; 76,9% mujeres; 65,8% vivía con una pareja, el 58,1% color de la piel de color marrón; 90, 6% para no fumadores; 70,9% no someterse a tratamiento neoadyuvante). Se evaluaron entre 36 y 02 horas antes de la cirugía (línea de base - T1), y en dos segmentos: entre 12 y 48 horas después de la cirugía (T2) y 10-días ± 2 días después de la cirugía (T3). Después de la aprobación de los comités de ética en la investigación de los sitios de estudio y el consentimiento de los participantes fueron aplicados a Revisado-Piper Fatigue Scale, Escala de Estrés Percibido, Índice de Capacidad de Adaptación, Hospital Anxiety and Depression Scale, Numerical Pain Scale y Sueño; Escala de Karnofsky (KPS). RESULTADOS. La prevalencia de la fatiga en los pacientes en el período preoperatorio de oncología quirúrgica fue del 25,6% (n = 30). Fatiga preoperatoria se asoció con la ansiedad, depresión, estrés, trastornos del sueño, el dolor y el estado funcional peor. De todos los instrumentos aplicados, KPS mostró mejores características relacionadas con la precisión de la evaluación de la fatiga. La incidencia de la fatiga en T2 y T3 era 32,3% (n = 32) y 22,7% (n = 17), respectivamente. La intensidad media de la fatiga fue moderado en todas las evaluaciones y la dimensión afectiva tenían puntuaciones significativamente más altas que las otras dimensiones. Después de la operación el estado civil y el índice de la capacidad de adaptación se asociaron con la fatiga en T3. Además, se observó que la capacidad de adaptación, la pérdida de la condición de sueño y el rendimiento afectado el desarrollo de la fatiga postoperatoria. CONCLUSIÓN. Este estudio longitudinal para el progreso en la construcción de conocimiento de la fatiga postoperatoria, dirigiendo la planificación de las medidas más eficaces para prevenir y tratar los síntomas. Hubo una reducción gradual de la aparición de la fatiga después de la cirugía del cáncer. La dimensión afectiva de la fatiga era la dimensión con mayor intensidad. En el preoperatorio, los aspectos emocionales (ansiedad, depresión y estrés), el dolor, el sueño y el estado funcional se asociaron con la fatiga, siendo esta última más importante presentar una mayor precisión. Después de la operación, los que no tienen pareja y peor capacidad de adaptación debe ser gestionada de forma más rigurosa, ya que tienen más fatiga que los otros pacientes. Además de estos factores, el sueño y el rendimiento deben ser investigados para el impacto de la evolución de la fatiga.
INTRODUÇÃO. Fadiga em pacientes submetidos à cirurgia oncológica é frequente e traz repercussão negativa para o indivíduo operado.Há muitas lacunas de conhecimento sobre essa experiência multidimensional, sobre os fatores envolvidos em sua ocorrência e intensidade. OBJETIVO. Avaliar a fadiga de pacientes submetidos à cirurgia oncológica. MÉTODO.Trata-se de uma coorte prospectiva aberta, com uma amostra inicial de 117 pacientes (idade média= 51,2 anos; 76,9% mulheres; 65,8% viviam com companheiro; 58,1% cor de pele parda; 90,6% não fumantes; 70,9% não realizaram tratamento neoadjuvante). Foram avaliados entre 36 e 02 horas antes da cirurgia (Baseline- T1), e em dois seguimentos: entre 12 e 48 horas após a cirurgia (T2) e 10dias ± 2 dias após a cirurgia (T3). Após aprovação pelos comitês de ética em pesquisa dos locais de estudo e consentimento dos participantes, foram aplicados a Escala de Fadiga de Piper-Revisada, Escala de Estresse Percebido, Índice de Capacidade Adaptativa, Escala Hospitalar de Ansiedade e Depressão, Escala Numérica de Dor e de Sono; Escala de Karnofsky. RESULTADOS. A prevalência de fadiga entre os pacientes em pré-operatório de cirurgia oncológica foi de 25,6% (n=30). Fadiga pré-operatória se associou à ansiedade, depressão, estresse, alterações de sono, dor e pior performance status. De todos os instrumentos aplicados, KPS apresentou melhores características relacionadas à precisão para avaliação de fadiga. A incidência de fadiga no T2 e no T3 foi de 17% (n=17) e de 8% (n=6), respectivamente. A intensidade média de fadiga foi moderada em todas as avaliações e a dimensão afetiva apresentou escores significativamente mais altos que das demais. No pós-operatório, o estado marital e índice de capacidade adaptativa se associaram à fadiga em T3. Ainda, observou-se que a capacidade adaptativa, o prejuízo de sono e a performance status impactaram a evolução de fadiga pós-operatória. CONCLUSÃO. Observou-se redução gradativa da ocorrência de fadiga após cirurgia oncológica. A dimensão afetiva da fadiga foi apresentada com maior intensidade. No pré-operatório, aspectos emocionais (ansiedade, depressão e estresse), dor, sono e performance status estiveram associados à fadiga, sendo o último o mais importante por apresentar melhor acurácia. No pós-operatório, aqueles sem companheiro e pior capacidade adaptativa devem ser assistidos com mais rigor pois apresentam mais fadiga que os demais pacientes. Além desses fatores, o sono e a performance devem ser investigadas pois causam impacto na evolução da fadiga.O presente estudo longitudinal permitiu avançar na construção de conhecimento sobre fadiga pós-operatória, direcionando o planejamento de ações mais efetivas para prevenção e tratamento do sintoma.
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Cirino, Camila Camarinha da Silva 1986. "Avaliação clínica do tratamento cirúrgico e não-cirúrgico de pacientes com periodontite agressiva." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290416.
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Orientador: Antônio Wilson SallumDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O presente estudo tem como objetivo avaliar, por meio dos parâmetros clínicos, o efeito das terapias periodontais cirúrgica e não-cirúrgica no tratamento da periodontite agressiva generalizada (PAG). Doze pacientes portadores de periodontite agressiva generalizada foram incluídos neste estudo clínico controlado randomizado com desenho experimental de boca dividida, e foram alocados em dois grupos: Grupo TNC (tratamento não-cirúrgico) - debridamento ultrassônico associado a raspagem manual; e Grupo TC (tratamento cirúrgico) - acesso cirúrgico para debridamento ultrassônico associado a raspagem manual. As avaliações clínicas foram realizadas antes do tratamento (baseline), 3 meses e 6 meses após o mesmo, considerando os seguintes parâmetros: índice de placa (IP), índice de sangramento à sondagem (ISS), profundidade de sondagem (PS), nível de inserção clínico (NIC) e recessão gengival (RG). Ambos os tratamentos promoveram ganho de inserção clínica e redução de profundidade de sondagem para todos os sítios em relação ao baseline, sem diferença estatística entre os grupos. As médias de redução de PS para bolsas moderadas foi de 1,3 mm para o grupo TNC e 1,2 mm para o grupo TC (p=0.79). As médias de ganho de inserção foram também semelhantes, com 1 mm para TNC e 0,8 mm para TC (p=0.44). Nas bolsas profundas, o grupo TNC apresentou 2,2 mm de redução de PS, enquanto o grupo TC apresentou redução de 2,9 mm (p=0.18). Quando NIC foi avaliado, o ganho no grupo TNC foi de 1,6 mm, e o grupo TC apresentou ganho de 2,4 mm (p=0.2). Como consequência de ambas as terapias, houve o surgimento de recessão gengival, com valores semelhantes entre os grupos. Dentro dos limites deste estudo, pode-se concluir que as terapias periodontais cirúrgica e não-cirúrgica foram capazes de promover melhoras clínicas em pacientes com periodontite agressiva generalizada
Abstract: This present study aimed to evaluate, based on clinical parameters, the effect of surgical and non surgical periodontal therapy in treatment of generalized aggressive periodontitis (GAP). Twelve patients with generalized aggressive periodontitis were included in this randomized controlled clinical study with experimental split-mouth design, and were allocated into two groups: NST Group (non surgical treatment) - ultrasonic debridement associated with manual scaling, and ST Group (surgical treatment) - access to surgical ultrasonic debridement associated with scaling manual. Clinical evaluations were performed before treatment (baseline), 3 months and 6 months after treatment, considering the following parameters: plaque index (PI), bleeding on probing index (BOP), probing depth (PD), clinical attachment level (CAL) and gingival recession (GR). Both treatments promoted gain in CAL and reduction in pocket depth for all sites, with no statistical difference between groups. Means of reduction of PD to moderate pockets was 1.3 mm for NST group and 1.2 mm for ST group (p=0.79). Gain of attachment were also similar, with group NST presenting 1 mm and 0.8 mm for group ST (p=0.44). In deep pockets, the NST group showed 2.2 mm of reduction of PD, while ST group decreased 2.9 mm (p=0.18). When CAL was evaluated, the gain in group NST was 1.6 mm, and ST group presented gain of 2.4 mm (p=0.2). The development of gingival recession was observed after both therapies, with similar values among groups. Within the limits of this study, it can conclude that surgical and non-surgical periodontal therapies were able to promote clinical improvements in patients with generalized aggressive periodontitis
Mestrado
Periodontia
Mestra em Clínica Odontológica
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Calhoun, William R. III. "Femtosecond Laser Beam Propagation through Corneal Tissue: Evaluation of Therapeutic Laser-Stimulated Second and Third-Harmonic Generation." VCU Scholars Compass, 2015. http://scholarscompass.vcu.edu/etd/3785.
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One of the most recent advancements in laser technology is the development of ultrashort pulsed femtosecond lasers (FSLs). FSLs are improving many fields due to their unique extreme precision, low energy and ablation characteristics. In the area of laser medicine, ophthalmic surgeries have seen very promising developments. Some of the most commonly performed surgical operations in the world, including laser-assisted in-situ keratomileusis (LASIK), lens replacement (cataract surgery), and keratoplasty (cornea transplant), now employ FSLs for their unique abilities that lead to improved clinical outcome and patient satisfaction.
The application of FSLs in medical therapeutics is a recent development, and although they offer many benefits, FSLs also stimulate nonlinear optical effects (NOEs), many of which were insignificant with previously developed lasers. NOEs can change the laser characteristics during propagation through a medium, which can subsequently introduce unique safety concerns for the surrounding tissues. Traditional approaches for characterizing optical effects, laser performance, safety and efficacy do not properly account for NOEs, and there remains a lack of data that describe NOEs in clinically relevant procedures and tissues. As FSL technology continues to expand towards new applications, FSL induced NOEs need to be better understood in order to ensure safety as FSL medical devices and applications continue to evolve at a rapid pace.
In order to improve the understanding of FSL-tissue interactions related to NOEs stimulated during laser beam propagation though corneal tissue, research investigations were conducted to evaluate corneal optical properties and determine how corneal tissue properties including corneal layer, collagen orientation and collagen crosslinking, and laser parameters including pulse energy, repetition rate and numerical aperture affect second and third-harmonic generation (HG) intensity, duration and efficiency. The results of these studies revealed that all laser parameters and tissue properties had a substantial influence on HG. The dynamic relationship between optical breakdown and HG was responsible for many observed changes in HG metrics. The results also demonstrated that the new generation of therapeutic FSLs has the potential to generate hazardous effects if not carefully controlled. Finally, recommendations are made to optimize current and guide future FSL applications.
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Campos, Fabrício Ribeiro de. "Prevalência de infecção de sítio cirúrgico em pacientes adultos num hospital geral do interior paulista." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-17012017-160117/.
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Introdução: As Infecções Relacionadas à Assistência á Saúde (IRAS) são consideradas um problema de saúde pública com implicações sociais e econômicas graves que geram sobrecarga nas instituições de saúde, aumentando o período de internação e elevando consideravelmente a morbimortalidade em pacientes hospitalizados. A infecção do sítio cirúrgico (ISC) se constitui como uma das mais temidas complicações decorrentes dos procedimentos cirúrgicos No Brasil, são escassos os estudos epidemiológicos sobre as infecções em pacientes submetidos à procedimentos anestésico cirúrgico. Objetivo: Identificar a prevalência de infecção de sítio cirúrgico em pacientes adultos submetidos à cirurgia num hospital geral privado filantrópico, de nível terciário do interior paulista, segundo o potencial de contaminação da ferida operatória. Materiais e Métodos: Trata-se de um estudo de corte transversal, com abordagem retrospectiva e quantitativa, aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. A população do estudo foi constituída 58 prontuários médicos de pacientes submetidos à cirurgia no referido hospital exceto nas especialidades de ortopedia e ginecologia, no período de janeiro de 2014 a dezembro de 2014 e que apresentaram infecção do sítio cirúrgico. Os dados foram coletados por meio de consulta aos prontuários e analisados por meio de estatística descritiva utilizando-se o programa Statistical Package for the Social Sciences, version 17.0 para Windows. Resultados: A taxa global de infecção do sítio cirúrgico foi de 1,9% (57/3.064), as especialidades com maiores taxas foram a neurocirurgia (3,5%), seguida pela cirurgia geral (2,0%). Ao se analisar a taxa de infecção por potencial de contaminação, nas cirurgias limpas foi de 1,0%, nas potencialmente contaminadas 1,8%, nas contaminadas 5,4% e nas infectadas 7,2%. Nas cirurgias limpas a maior taxa foi na neurocirurgia, na potencialmente contaminada foi na cirurgia torácica, na contaminada e infectada foi na cirurgia geral. E ressalta-se que 46,6% tiveram infecção de órgão ou cavidade. Conclusão: O presente estudo permitiu identificar as taxas globais de infecção do sítio cirúrgico e também, por especialidades e por potencial de contaminação, dados esses que podem contribuir para o planejamento das ações de prevenção e controle de Infecção do sítio cirúrgico no referido hospitalIntroduction: Healthcare-associated infections (HAI) are considered to be a public health problem with serious social and economic implications that overload health institutions, extend hospital length of stay and considerably increase morbidity- mortality among hospitalized patients. Surgical site infections (SSI) are one of the most feared complications from surgical procedures. There are few epidemiological studies in Brazil on infections among patients submitted to anesthetic-surgical procedures. Objective: To identify the prevalence of surgical site infection among adult patients submitted to surgery in a tertiary philantropic private general hospital in the interior of the state of São Paulo, according to the potential of contamination of the operative wound. Materials and Methods: This is a cross-sectional study, using a retrospective and quantitative approach, approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing, at the University of São Paulo. The study sample was made up of 58 medical records of patients submitted to surgery in this hospital, except for the orthopedics and gynecology specialties, from January to December 2014, who presented surgical site infection. Data were collected from the medical records and analyzed by means of descriptive statistics, using the Statistical Package for the Social Sciences software, version 17.0 for Windows. Results: Overall surgical site infection rate was 1.9% (57/3,064), and specialties with higher rates were neurosurgery (3.5%) and general surgery (2.0%). Regarding the infection rate by potential contamination, in clean surgeries it was 1.0%; in potentially contaminated surgeries, it was 1.8%; in contaminated surgeries, it was 5.4%; and in infected surgeries, it was 7.2%. Neurosurgery presented the highest rate in clean surgeries; thoracic surgery in potentially contaminated surgeries; whereas general surgery had the highest rate in contaminated and infected surgeries. It is worth highlighting that 46.6% reported organ or cavity infection. Conclusion: This study allowed to identify overall rates of surgical site infection, also by specialty and potential of contamination. These data can contribute to the planning of actions to prevent and control surgical site infection in the studied hospital
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Pinto, Fabiana de Souza. "Atenção auditiva e consciência fonológica em crianças com fissura labiopalatina com palatoplastia primária de 9 a 12 meses de idade." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/25/25143/tde-12062012-150656/.
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A fissura labiopalatina é uma malformação craniofacial congênita caracterizada pelo não fechamento do lábio e/ou palato. Várias podem ser as consequências trazidas por essa ruptura como alterações na fala, deglutição, mastigação, dentárias e auditivas. Diante disso, esses pacientes necessitam passar por cirurgias reparadoras, sendo a idade em que acontecerá um fator fundamental para que desenvolvimento das funções auditivas e orofaciais se encontre dentro do esperado ou próximo a ele. Há grande relação entre a fissura e alterações de orelha média, tendo como consequência a privação sensorial momentânea ou até mesmo a deficiência auditiva. A privação sensorial acarreta prejuízo para o desenvolvimento das habilidades auditivas e consecutivamente no desenvolvimento da fala e linguagem. Tendo em vista o exposto, o objetivo deste trabalho foi verificar a habilidade de atenção auditiva sustentada, dividida e seletiva e habilidade de consciência fonológica em crianças com fissura labiopalatina com intervenção na idade entre 9 e 12 meses. Foram avaliados 40 sujeitos, com idade entre 7 e 11 anos, com fissura labiopalatina, sem deficiência auditiva, que receberam palatoplastia primária entre os 9 e 12 meses de idade. Foram avaliadas as habilidades de atenção auditiva sustentada, dividida, seletiva, além da consciência fonológica por meio dos exames THAAS, DD, PSI e CONFIAS, respectivamente. Os resultados mostraram-se alterados em 22 (55%), 18 (45%), 13 (32,5%) e três (7,5%) para os respectivos testes THAAS, DD, PSI e CONFIAS. Foi encontrada correlação apenas entre os testes PSI e CONFIAS (p=0,02895). Conclui-se que maiores porcentagens de desempenho dentro do esperado para idade ocorreram para os testes de habilidade de atenção auditiva dividida (DD) e seletiva (PSI). O THAAS foi o teste de atenção auditiva com maior alteração. Poucos pacientes apresentaram alterações no teste que avaliou a habilidade de consciência fonológica.The cleft lip and palate is a congenital craniofacial malformation characterized by the lip and/or palate not joining. Several consequences can occur from this rupture such as alterations in speech, swallowing, chewing, dental and hearing. As a result of this, these patients need to undergo reconstructive surgeries, and the age it will happen is fundamental for the development of the auditory and orofacial functions to be within expected levels or close to them. There is great relation between the fissure and alterations of the middle ear, having as consequence the momentaneous sensory deprivation, or even the hearing deficiency. Sensory deprivation causes damage to the development of the auditory abilities and sequentially to the language and speech development. In view of what has been stated, the objective of this work was to verify the auditory sustained, divided and selective attention, and phonological awareness ability in children with cleft palate with intervention between the ages of 9 and 12 months. 40 subjects were evaluated, aged between seven and 11 years of age, with cleft palate, without auditory deficiency, who had received primary palatoplasty between the 9 and 12 months of age. We evaluated the auditory sustained, divided and selective abilities, and phonological awareness by means of THAAS, DD, PSI and CONFIAS, respectively. The results were abnormal in 22 (55%), 18 (45%), 13 (32.5%) and three (7.5%) for respective tests THAAS, DD, PSI and CONFIAS. Correlation was found only between PSI, and CONFIAS tests (p=0,02895). We can conclude that higher percentages of performance within expected for age occurred for the tests of auditory divided attention (DD) and selective attention (PSI). The THAAS was the test of auditory attention with bigger alteration. Few patients presented alterations in the test that evaluated the phonological awareness ability.
Books on the topic "Surgical Procedures, Operative"
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B, Kaufman Dixon, and Northwestern University (Evanston, Ill.), eds. Northwestern handbook of surgical procedures. Georgetown, Tex: Landes Bioscience, 2005.
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Soper, Nathaniel J. Northwestern handbook of surgical procedures. 2nd ed. Austin, Tex: Landes Bioscience, 2011.
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A, Jaffe Richard, and Samuels Stanley I, eds. Anesthesiologist's manual of surgical procedures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 1999.
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H, Bell Richard. Northwestern handbook of surgical procedures. Georgetown, Tex: Landes Bioscience, 2005.
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A, Jaffe Richard, Schmiesing Cliff, and Golianu Brenda, eds. Anesthesiologist's manual of surgical procedures. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2009.
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L, Dent Thomas, ed. Surgical tips. New York: McGraw-Hill Information Services Co., Health Professions Division, 1989.
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A, Jaffe Richard, and Samuels Stanley I, eds. Anesthesiologist's manual of surgical procedures. New York: Raven Press, 1994.
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Cady, Blake, and Walley J. Temple. Surgical Techniques and outcomes. Philadelphia: W.B. Saunders, 2000.
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Karakousis, Constantine P. Atlas of Operative Procedures in Surgical Oncology. New York, NY: Springer New York, 2015. http://dx.doi.org/10.1007/978-1-4939-1634-4.
Full textBook chapters on the topic "Surgical Procedures, Operative"
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Cuschieri, A., L. K. Nathanson, and G. Buess. "Basic Surgical Procedures." In Operative Manual of Endoscopic Surgery, 83–102. Berlin, Heidelberg: Springer Berlin Heidelberg, 1992. http://dx.doi.org/10.1007/978-3-662-22257-7_8.
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Bali, Rishi Kumar. "Operating Room Protocols and Infection Control." In Oral and Maxillofacial Surgery for the Clinician, 173–94. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-15-1346-6_9.
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AbstractIn the modern day’s Oral and Maxillofacial surgical practice, complex surgical and aesthetical procedures are being carried out associated with an increased risk of infectious complications. Therefore, to ensure better outcomes of the surgical procedures, it is absolutely necessary that appropriate measures must be taken to decrease the incidence of associated infections. The practices to be carried out for infection control include proper scrubbing procedures for both patient and the operator, specific protocols to be followed by the operating personnel at the time of procedures, proper handling of the instruments and maintaining an aseptic environment throughout the procedure. The main aim of this chapter is to provide information on the preoperative, operative and post-operative protocols that should be adhered to improve the safety of the patients undergoing surgical procedures.
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Orady, Mona E., and Rakshanda Aslanova. "Office Operative Hysteroscopy: Polyp and Submucosal Fibroid Removal." In Office-Based Gynecologic Surgical Procedures, 117–31. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1414-2_9.
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Karakousis, Constantine P. "Surgical Technique in Cancer Surgery." In Atlas of Operative Procedures in Surgical Oncology, 1–11. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1634-4_1.
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Piper, Greta L. "Operative Procedures in the Intensive Care Unit." In Principles of Adult Surgical Critical Care, 515–20. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-33341-0_46.
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Karakousis, Constantine P. "The Surgical Importance of the Inferior Epigastric Vessels." In Atlas of Operative Procedures in Surgical Oncology, 287–95. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1634-4_44.
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Karakousis, Constantine P. "Axillary Node Dissection." In Atlas of Operative Procedures in Surgical Oncology, 57–65. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1634-4_10.
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Karakousis, Constantine P. "In Continuity Axillary and Supraclavicular Node Dissection." In Atlas of Operative Procedures in Surgical Oncology, 67–74. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1634-4_11.
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Karakousis, Constantine P. "Neck Dissection." In Atlas of Operative Procedures in Surgical Oncology, 75–82. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1634-4_12.
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Karakousis, Constantine P. "Tumor at the Shoulder Point." In Atlas of Operative Procedures in Surgical Oncology, 83–86. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1634-4_13.
Full textConference papers on the topic "Surgical Procedures, Operative"
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Maldonado, Ramon. "Learning the Structure of Surgical Procedures from Operative Notes." In 2015 International Conference on Healthcare Informatics (ICHI). IEEE, 2015. http://dx.doi.org/10.1109/ichi.2015.86.
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Bechtold, Raphael, Benjamin Garlow, Renee Liu, Arushi Tandon, Alexandra Szewc, William Zhu, Olivia Musmanno, et al. "Minimizing Cotton Ball Retention in Neurological Procedures." In 2020 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/dmd2020-9042.
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Abstract Neurosurgical operations are long and intensive medical procedures, during which the surgeon must constantly have an unobscured view of the brain in order to be able to properly operate, and thus must use a variety of tools to clear obstructions (like blood and fluid) from the operating area. Currently, cotton balls are the most versatile and effective option to accomplish this as they absorb fluids, are soft enough to safely manipulate the brain, act as a barrier between other tools and the brain, and function as a spacer to keep anatomies of the brain open and visible during the operation. While cotton balls allow neurosurgeons to effectively improve visibility of the operating area, they may also be accidentally left in the brain upon completion of the surgery. This can lead to a wide range of post-operative risks including dangerous immune responses, additional medical care or surgical operations, and even death. This project seeks to develop a unique medical device that utilizes ultrasound technology in order to minimize cotton retention after neurosurgical procedures in order to reduce undesired post-operative risks, and maximize visibility.
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Onal, Sinan, Susana Lai-Yuen, and Stuart Hart. "Design of a Universal Laparoscopic Suturing Device." In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53187.
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Minimally invasive surgery (MIS) or laparoscopic surgery has changed the focus of surgery and has become an alternative to open surgical procedures. Operations are performed through small incisions in the abdomen thus avoiding the need for large incisions. This results in less tissue trauma, less scarring, and faster post-operative recovery time. However, the inherent challenges of laparoscopic procedures include limited visibility, constrained working space and the need for advanced surgical tools to safely and efficiently perform the surgical procedure. It is also necessary for surgeons to obtain advanced surgical training to perform these procedures.
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Johnson, L. R., M. D. Byrne, and M. K. O’Malley. "Comparison of Performance Metrics for Real-Time Haptic Feedback in Surgical Skill Training." In The Hamlyn Symposium on Medical Robotics: "MedTech Reimagined". The Hamlyn Centre, Imperial College London London, UK, 2022. http://dx.doi.org/10.31256/hsmr2022.63.
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Endovascular surgery involves minimally invasive sur- gical techniques that can result in significantly shorter operation times and hospital stays, lower complication rates, less blood loss, and lower rates of postoperative mechanical ventilation and atrial fibrillation than the equivalent open procedures [1], [2]. Repeated practice is central to skill acquisition, and minimally invasive procedures like endovascular surgery may require more or specialized practice compared to traditional surgery. For example, despite known benefits of endovascular aortic valve replacement compared to traditional surgical methods, Smith et al. attributed observations of higher rates of stroke, transient ischemic attacks, and major vascular complications to a protracted learning curve for the endovascular approach [3]. Virtual reality endovascular surgical simulators can be loaded with a patient’s pre-operative CT scan, enabling rehearsal of difficult cases before operating. Simulators are also accessible to trainees, giving opportunities for additional practice in navigating to hard-to-reach vas- cular structures, or exposure to rare procedures. Still, surgical simulators lack the provision of real-time and objective performance feedback. Instead, feedback is only available after the completion of a surgical task, and often does not provide the trainee with insight into how they should change their task performance strategies to achieve performance goals. Objective measures of skill derived from endovascular guidewire movement kinematics that characterize tool tip movement smoothness have been shown to correlate with expertise [4], [5]. Such metrics have not yet been used during training as real-time performance feedback, despite evidence that providing feedback can improve training outcomes [6]. Our approach to providing real-time performance feed- back during surgical skill training is intended to address this gap. We propose to use estimates of spectral arc length (SPARC), idle time, and average velocity to quantify task performance, then encode these measures as vibrotactile cues displayed to trainees in a wearable haptic device (see Fig. 1).
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Fuchs, T. E., E. A. Felinska, A. Kogkas, G. P. Mylonas, B. P. Müller- Stich, and F. Nickel. "iSurgeon: Augmented reality telestration for improved surgical training." In The Hamlyn Symposium on Medical Robotics: "MedTech Reimagined". The Hamlyn Centre, Imperial College London London, UK, 2022. http://dx.doi.org/10.31256/hsmr2022.42.
Full textAbstract:
Minimally invasive surgery (MIS) has become the gold standard in many surgical procedures [1]. Although it provides a better outcome for patients it has a slower learning curve [2, 3]. In laparoscopic surgery trainees need to learn how to interpret the operative field dis- played on the laparoscopic screen. Experts currently guide trainees only verbally during laparoscopic surgi- cal procedures. We developed the iSurgeon which al- lows the instructor to make hand gestures that are de- tected by an RGB-D camera (colour resolution: 1920x1080 pixels, 30 fps, depth resolution: 512x424 pixels, 30 fps) and displayed on the laparoscopic screen in augmented reality (AR) to provide visual expert guidance (telestration) [4]. Thus, the expert can provide clearer instructions by using gestures in addition to ver- bal instructions. This study analysed the effect of iSur- geon guided instructions on the gaze behaviour of in- structor and trainee during laparoscopic surgery. We also aimed to find out if the iSurgeon affects the per- formance and the cognitive workload of the trainees.
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Sun, Xiaochuan, and Shahram Payandeh. "Estimation of Incision Patterns Based on Visual Tracking of Surgical Tools in Minimally Invasive Surgery." In ASME 2010 International Mechanical Engineering Congress and Exposition. ASMEDC, 2010. http://dx.doi.org/10.1115/imece2010-37827.
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In minimally invasive surgery, the positions of surgical tools are important in multiple instruments set-up and procedures. Typically, each surgery requires 4–5 incision holes and for each specific procedure, the layout of points defines specific pattern. Taking advantage of this possible one-to-one relationship between a specific procedure in minimally invasive surgery and the incision patterns, such patterns can be utilized in tele-monitoring of trainee during an emulated surgical operation. For example, in performance evaluation of trainee, this procedure would automatically estimate and verify the initial incision pattern to that of the predefined expected template associated with a particular surgical procedure. In this paper, we propose and analyze two models, based on color and shape respectively, to reconstruct the pattern. Both approaches use image information only to reconstruct the incision patterns in three dimensional space. The challenge of monocular endoscopic view is the lack of depth perception which hindered the vision-based tracking of laparoscopic tools. To address the problem, we present a method to determine not only the spatial tip position of the surgical tools, but also their orientation with respect to the camera coordinate frame. Detailed formulation shows that how segmented tool edges and camera field of view localize the 3D orientations of tools. Then, 3D position of the tool tip is reconstructed using either color or edge detection method. Finally, the orientations and the position of tool tips uniquely determine the poses of the tools. From above procedures, geometrical models of cylindrical tools can be constructed in each sequence of mono-camera images. To further use the tracking result in order to localize the incision point, we computed the vectors of the cylindrical tool center lines at multiple poses at number of frames. Extracted incision point is further analyzed as a recognition pattern to map into the patients’ pre-operative incision procedure. Accuracy of 3D tool pose estimation and incision pattern is evaluated in real image sequences with known ground truth.
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Bora, Rashmi Rekha. "Modified posterior pelvic exenteration and rectosigmoid anastomosis for advance epithelial ovarian cancer: A safe cytoreductive procedure." In 16th Annual International Conference RGCON. Thieme Medical and Scientific Publishers Private Ltd., 2016. http://dx.doi.org/10.1055/s-0039-1685294.
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Introduction: Surgery plays an important role in the management of advanced stage ovarian cancer and is complex involving surgical procedures including peritonectomy, splenectomy, diaphragmatic stripping, retroperitoneal lymph node dissection and bowel resection including resection of recto-sigmoid. Objective: To assess the safety and efficacy of the patients undergoing modified posterior pelvic exenteration and rectosigmoid anastomosis achieving in optimal cytoreduction. Methods: Between June 2011 and June 2014 a total of 100 patients underwent surgical cytoreduction for advanced epithelial ovarian cancer of which 20 patients had undergone modified posterior pelvic exenteration with rectosigmoid anastomosis. The present study includes a retrospective analysis of these 20 patients. Rectosigmoid anastomosis was done using circular stapler in these patients. All patients had a PS score of 1 or 2. Results: The median age of patients was 50 years. The optimal status of no macroscopic residual disease was achieved in all patients. Modified posterior pelvic exenteration with rectosigmoid anastomosis was carried out to achieve optimal status of surgical cytoreduction in 20 patients out of which fifteen patients had primary surgical cytoreduction, three patients had interval surgical cytoreduction surgery after receiving three cycles of neoadjuvant chemotherapy with paclitaxel & carboplatin while two patients had this procedure as a part of secondary surgical cytoreduction. The most common histology was papillary serous carcinoma. Average blood loss was 500 ml. Mean operative time was 6 hours. There were no intra operative complications. Bowel movements returned to normal in 3 to 5 days. The median length of hospital stay was 7 days. The median time to start postoperative chemotherapy was 32 days. There was no major morbidity and mortality. Conclusion: Modified posterior pelvic exenteration with rectosigmoid anastomosis should be performed when indicated as a part of cytoreduction. In our experience this is a safe and effective procedure to achieve optimal status in advanced ovarian cancer.
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Gidde, Sai Teja Reddy, Tololupe Verissimo, Nuo Chen, Parsaoran Hutapea, and Byoung-gook Loh. "Neural Network Modeling of Maximum Insertion Force of Bevel-Tip Surgical Needle." In ASME 2018 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2018. http://dx.doi.org/10.1115/imece2018-88383.
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Recently there has been a growing interest to develop innovative surgical needles for percutaneous interventional procedures. Needles are commonly used to reach target locations inside of the body for various medical interventions. The effectiveness of these procedures depends on the accuracy with which the needle tips reach the targets, such as a biopsy procedure to assess cancerous cells and tumors. One of the major issues in needle steering is the force during insertion, also known as the insertion (penetration) force. The insertion force causes tissue damage as well as tissue deformation. It has been well studied that tissue deformation causes the needle to deviate from its target thus causing an ineffective procedure. Simulation of surgical procedures provides an effective method for a robot-assisted surgery for pre- and intra-operative planning. Accurate modeling of the mechanical behavior on the interface of surgical needles and organs, specifically the insertion force, has been well recognized as a major challenge. Overcoming such obstacle by development of robust numerical models will enable realistic force feedback to the user during surgical simulation. This study investigates feasibility of predicting the insertion force of bevel-tip needles based on experimental data using neural network modeling. Simulation of the proposed neural network model is performed using Kera’s Python Deep Learning Library with TensorFlow as a backend. The insertion forces of needles with different bevel-tip angles in gel tissue phantom are measured using a specially designed automated needle insertion test setup. Input-output datasets are generated where the inputs are defined as bevel-tip angles and gel tissue phantom stiffness, and the output is defined as the insertion force. A properly trained neural network then maps the input data to the output data and the input-output dataset is supplied to train a neural network. Its performance is then evaluated using different and unseen input-output dataset. This paper shows that the proposed neural network model accurately predicts the insertion force.
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Hanson, Willard L., Nancy L. Michael, Choong-Un Kim, and Bumsoo Han. "Development of Quantum Dot-Embedded Nanoparticles for Biothermal Imaging." In ASME 2007 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2007. http://dx.doi.org/10.1115/sbc2007-176185.
Full textAbstract:
Recent surgical management of cancer tends toward minimally invasive surgical techniques since tumors can be detected smaller than ever due to the advance of cancer diagnostic technologies. Many of these surgical procedures are thermal therapies where a localized freezing or heating zone (i.e. thermal lesion) is created to destroy tumors without damaging adjacent normal tissues. The outcomes of these innovative and less invasive surgeries, however, are significantly impaired by the limited image-guidance of the thermal lesion during the procedures. Since the primary clinical objective of these surgeries is to eradicate diseased tissues while sparing the adjacent normal tissue, accurate intra-operative monitoring of the thermal lesion is critical. Moreover, in many surgical situations, sparing adjacent tissue is not only desired, but imperative since major blood vessels, nerve bundles and surrounding organs are susceptible to thermal injury. However, currently available monitoring techniques have limited accuracy or accessibility, and/or are not capable of monitoring the lesion in real-time during the procedure. In our recent study [1], we demonstrated the feasibility of non-invasive thermometry using quantum dot (QD) as temperature probe. Although its feasibility was demonstrated, several limitations should be addressed before more rigorous clinical applications. Especially the lower quantum yield of core/shell QDs should be significantly improved for deeper tissue imaging. In the present study, QD-embedded nano-composite particles were developed for deeper tissue imaging and its temperature dependent fluorescence was characterized.
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Onbasıog˘lu, Esin, Bas¸ar Atalay, Dionysis Goularas, Ahu H. Soydan, Koray K. S¸afak, and Fethi Okyar. "Visualisation of Burring Operation in Virtual Surgery Simulation." In ASME 2010 10th Biennial Conference on Engineering Systems Design and Analysis. ASMEDC, 2010. http://dx.doi.org/10.1115/esda2010-25233.
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Virtual reality based surgical training have a great potential as an alternative to traditional training methods. In neurosurgery, state-of-the-art training devices are limited and the surgical experience accumulates only after so many surgical procedures. Incorrect surgical movements can be destructive; leaving patients paralyzed, comatose or dead. Traditional techniques for training in surgery use animals, phantoms, cadavers and real patients. Most of the training is based either on these or on observation behind windows. The aim of this research is the development of a novel virtual reality training system for neurosurgical interventions based on a real surgical microscope for a better visual and tactile realism. The simulation works by an accurate tissue modeling, a force feedback device and a representation of the virtual scene on the screen or directly on the oculars of the operating microscope. An intra-operative presentation of the preoperative three-dimensional data will be prepared in our laboratory and by using this existing platform virtual organs will be reconstructed from real patients’ images. VISPLAT is a platform for virtual surgery simulation. It is designed as a patient-specific system that provides a database where patient information and CT images are stored. It acts as a framework for modeling 3D objects from CT images, visualization of the surgical operations, haptic interaction and mechanistic material-removal models for surgical operations. It tries to solve the challenging problems in surgical simulation, such as real-time interaction with complex 3D datasets, photorealistic visualization, and haptic (force-feedback) modeling. Surgical training on this system for educational and preoperative planning purposes will increase the surgical success and provide a better quality of life for the patients. Surgical residents trained to perform surgery using virtual reality simulators will be more proficient and have fewer errors in the first operations than those who received no virtual reality simulated education. VISPLAT will help to accelerate the learning curve. In future VISPLAT will offer more sophisticated task training programs for minimally invasive surgery; this system will record errors and supply a way of measuring operative efficiency and performance, working both as an educational tool and a surgical planning platform quality.
Reports on the topic "Surgical Procedures, Operative"
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Harris, Gregory, Brooke Hatchell, Davelin Woodard, and Dwayne Accardo. Intraoperative Dexmedetomidine for Reduction of Postoperative Delirium in the Elderly: A Scoping Review. University of Tennessee Health Science Center, July 2021. http://dx.doi.org/10.21007/con.dnp.2021.0010.
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Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain. Methods: The authors developed eligibility criteria for inclusion of articles and performed a systematic search of several databases. Each of the authors initially selected five articles for inclusion in the scoping review. We created annotated literature tables for easy screening by co-authors. After reviewing the annotated literature table four articles were excluded, leaving 11 articles for inclusion in the scoping review. There were six level I meta-analysis/systematic reviews, four level II randomized clinical trials, and one level IV qualitative research article. Next, we created a data-charting form on Microsoft Word for extraction of data items and synthesis of results. Results: Two of the studies found no significant difference in POD between dexmedetomidine groups and control groups. The nine remaining studies noted decreases in the rate, duration, and risk of POD in the groups receiving dexmedetomidine either intraoperatively or postoperatively. Multiple studies found secondary benefits in addition to decreased POD, such as a reduction of tachycardia, hypertension, stroke, hypoxemia, and narcotic use. One study, however, found that the incidence of hypotension and bradycardia were increased among the elderly population. Implications for Nursing Practice: Surgery is a tremendous stressor in any age group, but especially the elderly population. It has been shown postoperative delirium occurs in 17-61% of major surgery procedures with 30-40% of the cases assumed to be preventable. Opioid administration in the elderly surgical population is one of the most significant risk factors for developing POD. With anesthesia practice already leaning towards opioid-free and opioid-limited anesthetic, the incorporation of dexmedetomidine could prove to be a valuable resource in both reducing opioid use and POD in the elderly surgical population. Although more research is needed, the current evidence is promising.
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Lumpkin, Shamsie, Isaac Parrish, Austin Terrell, and Dwayne Accardo. Pain Control: Opioid vs. Nonopioid Analgesia During the Immediate Postoperative Period. University of Tennessee Health Science Center, July 2021. http://dx.doi.org/10.21007/con.dnp.2021.0008.
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Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to providing adequate pain relief, the predicted cost burden of an opioid-free or opioid-sparing approach is significantly less than traditional methods. Methods The following groups were considered in our inclusion criteria: those who speak the English language, all races and ethnicities, male or female, home medications, those who are at least 18 years of age and able to provide written informed consent, those undergoing inpatient or same-day surgical procedures. In addition, our scoping review includes the following exclusion criteria: those who are non-English speaking, those who are less than 18 years of age, those who are not undergoing surgical procedures while admitted, those who are unable to provide numeric pain score due to clinical status, those who are unable to provide written informed consent, and those who decline participation in the study. Data was extracted by one reviewer and verified by the remaining two group members. Extraction was divided as equally as possible among the 11 listed references. Discrepancies in data extraction were discussed between the article reviewer, project editor, and group leader. Results We identified nine primary sources addressing the use of ketamine as an alternative to opioid analgesia and post-operative pain control. Our findings indicate a positive correlation between perioperative ketamine administration and postoperative pain control. While this information provides insight on opioid-free analgesia, it also revealed the limited amount of research conducted in this area of practice. The strategies for several of the clinical trials limited ketamine administration to a small niche of patients. The included studies provided evidence for lower pain scores, reductions in opioid consumption, and better patient outcomes. Implications for Nursing Practice Based on the results of the studies’ randomized controlled trials and meta-analyses, the effects of ketamine are shown as an adequate analgesic alternative to opioids postoperatively. The cited resources showed that ketamine can be used as a sole agent, or combined effectively with reduced doses of opioids for multimodal therapy. There were noted limitations in some of the research articles. Not all of the cited studies were able to include definitive evidence of proper blinding techniques or randomization methods. Small sample sizes and the inclusion of specific patient populations identified within several of the studies can skew data in one direction or another; therefore, significant clinical results cannot be generalized to patient populations across the board.
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Shah, Jeenam, Jayalakshmi T.K, Bhumika Madhav, Sharad Bhalekar, Dhanaji Rewande, and Shantesh Kaushik. Unusual Bronchial Foreign Body with a Bizarre Entry Path. Science Repository, March 2024. http://dx.doi.org/10.31487/j.jscr.2024.01.05.
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Foreign body in the bronchus is usually aspirated, ingested or deposited. Entry of a bronchial foreign body through the neck via a rent in the trachea is rare. A freak accident occurred when our 58 year old patient was overseeing crane operation at 4- a steel plant and a metallic foreign body pierced the patient’s trachea and was lodged in his right bronchus intermedius. Metallic body was removed using a snare via a flexible bronchoscope. A morbid open thoracic surgery was avoided by a timely procedure. Our case highlights that foreign body in the lungs can also enter via open penetrating wounds in the neck or chest and can be removed by bronchoscopy avoiding complex surgical procedures.
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Alenezi, Ali, Athary Saleem, Hamad Alajmi, Dalal Al Husainan, Odai Al Shadifat, and Ahmed Bader. Intraoperatively Diagnosed Double Cystic Duct During Laparoscopic Cholecystectomy: A Case Report of a Surgical Dilemma for the Operating Surgeons. Science Repository, April 2024. http://dx.doi.org/10.31487/j.ajscr.2024.01.04.
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Introduction and Importance: A double cystic duct with a single gallbladder is one of the extremely uncommon variations of the cystic duct and only a few cases were reported in literature. Case Presentation: A 33-year-old female, with an unremarkable medical history, presented to the emergency department with a 2-day history of right upper quadrant abdominal (RUQ) pain. The abdominal pain was gradually increasing in intensity radiating to the back and was associated with anorexia and multiple episodes of vomiting. Abdominal examination revealed RUQ pain and tenderness. Abdominal ultrasonography was performed, showing a markedly distended gallbladder with evidence of a few calculi one of which was impacted at the neck. laparoscopic cholecystectomy was done within 2 days of admission during which another luminal structure was identified that suggested a double cystic duct. Clinical Discussion: Anomalies of the biliary tree are common with the classical anatomical picture presenting in only 33% of cholecystectomy cases. However, the presence of a double cystic duct is a rare variation, especially in the case of a single gallbladder. The identification of such anomaly can be achieved preoperatively using imaging modalities or it can be identified during the surgical procedure itself. such identification reduces the chances of postoperative comorbidities. Conclusion: Pre-operative identification of biliary tract anomalies by different imaging modalities is limited. Hence the importance of cautiousness and achieving a proper critical view of safety intra-operatively to prevent possible complications intra- and post-operatively. Our case report emphasizes the diagnostic and surgical challenges of the double cystic duct.
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Liu, Xin-Yu, Yu-Meng Qin, Wei Su, Tian-Yu Li, Xiangjun Bai, Zhanfei Li, and Wei-Ming Xie. Resuscitative thoracotomy at operating room as a protective factor for death compared with resuscitative thoracotomy at emergency department in patients with severe thoracic injuries: a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, February 2023. http://dx.doi.org/10.37766/inplasy2023.2.0004.
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Review question / Objective: We aimed to compare the death risk of operating room thoracotomy and emergency department thoracotomy for patients with severe thoracic injuries by conducting systematic review and meta-analysis. Condition being studied: Duo to the high mortality of severe thoracic and cardiac trauma, treatment for severe thoracic trauma patients has become a great challenge. Resuscitative thoracotomy, which included emergency department thoracotomy (EDT) and operating room thoracotomy (ORT), is a surgical procedure to rescue severe thoracic patients, especially for patients with traumatic cardiac arrest and tamponade. However, it was still controversial that whether EDT or ORT was superior to the patients suffered from severe thoracic injuries.