2,833,898 research outputs found
Tactile Feedback for Artery Detection in Minimally Invasive Robotic Surgery –Preliminary Results of a New Approach
No full textMinimally invasive robotic surgery (MIRS) entails
total absence of haptic feedback due to the spatial separation
of patient and surgeon. In conventional surgery, however,
palpation to detect superficial arteries by a slight pulsation is
an important, commonly applied, and security-relevant procedure.
Therefore, an ultrasound based unidirectional sensor for
MIRS was developed feeding back kinesthetic impulses to the
surgeon-sided haptic input device
René Géronimo Favaloro : pioneer of Cardiac Surgery
No full textDr. René G. Favaloro moved to the Cleveland Clinic in 1962 and proceeded to reshape the face of cardiac surgery as we knew it. Together with his colleagues at the Cleveland Clinic, Drs. Effler, Sones, Proudfit, Groves, Sheldon and countless others, he contributed to the double internal mammary arterymyocardial implantation by the Vineberg method, and by May 1967, he reconstructed the right coronary artery by the saphenous vein graft interposition. These landmark procedures paved the way for the aorto-coronary saphenous vein bypass graft in October 1967. Many similar breakthroughs ensued, with the application of the bypass technique to the left coronary artery, the combination of coronary artery bypass graft with left ventricular reconstruction and valve repair/replacement and finally, by December, a double bypass to the right coronary artery and anterior descending branch of the left coronary artery. In June, 1971, Dr. Favaloro decided to leave the Cleveland Clinic and return to Argentina where he created a medical centre, a teaching unit, a research department and finally an Institute of Cardiology and Cardiovascular Surgery. This was his greatest personal ambition. Over and above his brilliant mind and craft, Dr. Favaloro was a man of integrity, courage, honesty and humility, whose name will never cease to reverberate throughout the history of medicine.peer-reviewe
Women and genital cosmetic surgery
No full textThis Issues Paper critically explores female genital cosmetic surgery in the Victorian context: to better understand what it is, who is undertaking it, and their reasons for doing so. The incidence of female genital cosmetic surgery appears to be increasing. This trend has been the subject of substantial analysis and opinion, but there is a lack of rigorous evidence on risks, efficacy, complications, and patient satisfaction. This Issues Paper considers how both individual and sociocultural factors are likely to contribute to the emerging trend, and how professional bodies, health professionals, and advocates might respond. It is intended as a starting point for further conversation, evidence-gathering, and action
Robotics in plastic surgery
No full textThe advent of robotic surgery has revolutionized the modern treatment of a multitude of surgical diseases. With its enhanced precision, greater degrees of freedom, superior three-dimensional vision, improved resolution, and tremor elimination, robotic surgery is now playing a pivotal role in minimally invasive gynecologic, cardiothoracic, urologic, otolaryngologic, and gastrointestinal procedures. During the past decade, the field of plastic and reconstructive surgery has also started to embrace this innovative technology, especially for challenging reconstructive cases. Robotic surgery has not only enabled plastic surgeons to perform flap harvest procedures with minimal donor-site morbidity and enhanced cosmesis, but it has also allowed them to perform procedures never possible before. In this review, we illustrate the current clinical applications of robotics in plastic surgery and analyze their limitations based on the literature and our own experience in the field. We finish by presenting the technological challenges restricting the widespread use of robotics in plastic surgery, and outline some of our recent research efforts aimed at overcoming those limitations and promoting broader application of this innovative technology. © Springer Science + Business Media New York 2016
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
No full text8 páginasBackground: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study
aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs
were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community
SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18¿49, 50¿69, 70 or more
years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients
aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst
case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients
remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative
vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case
115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of
the general population
A New 3D Tool for Planning Plastic Surgery
No full textFace plastic surgery (PS) plays a major role in today medicine. Both for reconstructive and cosmetic surgery, achieving harmony of facial features is an important, if not the major goal. Several systems have been proposed for presenting to patient and surgeon possible outcomes of the surgical procedure. In this paper, we present a new 3D system able to automatically suggest, for selected facial features as nose, chin, etc, shapes that aesthetically match the patient's face. The basic idea is suggesting shape changes aimed to approach similar but more harmonious faces. To this goal, our system compares the 3D scan of the patient with a database of scans of harmonious faces, excluding the feature to be corrected. Then, the corresponding features of the k most similar harmonious faces, as well as their average, are suitably pasted onto the patient's face, producing k+1 aesthetically effective surgery simulations. The system has been fully implemented and tested. To demonstrate the system, a 3D database of harmonious faces has been collected and a number of PS treatments have been simulated. The ratings of the outcomes of the simulations, provided by panels of human judges, show that the system and the underlying idea are effectiv
Superior Mesenteric Artery Syndrome. An Infrequent Complications of Scoliosis Surgery.
No full textSuperior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment. [ABSTRACT FROM AUTHOR
Bowel Preparation for Colorectal Surgery: Have All Questions Been Answered?
No full textRosenberg and colleagues1 first proposed the use of nonabsorbable oral antibiotic preparation (OAB) for colorectal surgery in 1971. In a randomized clinical trial, they demonstrated a reduction in surgical site infection and anastomotic leak rates after combined mechanical bowel preparation (MBP) and 1 or 2 nonabsorbable oral antibiotics (phthalylsulphathiazole and phthalylsulphathiazole and neomycin, respectively) compared with MBP alone
E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study
No full textCoronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders’ median age was 44.5 (IQR 36–60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated
Breast cancer surgery in older women : outcomes of the Bridging Age Gap in Breast Cancer study
No full textBackground
In older women breast cancer (BC) surgery is often non-standard or omitted due to concerns about morbidity. The Age Gap prospective multi-centre cohort study aimed to determine factors influencing selection for and outcomes from surgery for older BC patients.
Methods
Women >70 with operable BC were recruited from 56 UK breast units between 2013-2018. Data on patient and tumour characteristics were correlated with type of surgery to the breast (breast conservation surgery [BCS], mastectomy) and axilla (axillary node clearance [ANC], sentinel node biopsy [SLNB] or no axillary surgery [NAS]) using univariate and multivariate analysis. Oncologic, adverse event and Quality of life (QoL) outcomes were monitored for 2 years.
Results
Of 3375 recruited women, surgery was performed in 2816. There were 62 bilateral tumours, giving 2854 surgical events. The median age was 76 (range 70-95). Breast surgery comprised mastectomy in 1138, BCS in 1798. Axillary surgery comprised 575 ANC, 2203 SLNB and 76 NAS. Age, frailty, dementia and comorbidities were predictors of mastectomy (RR 1.06, CI 1.05-1.08). Frailty and comorbidity were significant predictors of NAS (RR 0.91, CI 0.87-0.96). The rate of adverse events was moderate (551/2854, 19.3%) with no 30 day mortality. Long term QoL and functional independence were adversely affected by surgery.
Conclusions
Age, ill health and frailty all impact on surgical decision making for BC. BC surgery is safe with serious adverse events being rare and no mortality. However surgery has a negative impact on QoL and independence which must be considered when counselling patients about choices
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