ABSTRACT
Objective To introduce the hydro-dissection technique and its application in ultrasound-guided percutaneous thermal ablation therapy of neck nodular lesions. Methods A total of 1 126 patients suffering from neck nodular diseases received percutaneous thermal therapy using radiofrequency ablation or microwave ablation from May 2005 to April 2013. As a part of the treatment procedure, ultrasound-guided injection of separating liquid was performed into between the target nodules and surrounding structures to form a separating zone prior to ablation. The roles of hydro-dissection technique in improving the safety of puncture route, reducing the thermal injury to normal tissues, and enhancing the curative effects of ablation were analyzed. Results Hydro-dissection technique was successfully performed in as many as fourteen parts related to the thyroids, parathyroids, submandibular glands and lymph nodes. The key points and ultrasonic characteristics of this maneuver were well established and understood. Compared with those not receiving the technique, those receiving the technique had significantly reduced heat damage to lesion-adjacent structures (0.7% vs 15%, P < 0.01) and decreased incomplete ablation rate of the lirst try (0.29% vs 7.4%, P < 0.01). Conclusion Hydro-dissection technique under ultrasound-guidance is easy to perform, has good repeatability and reliable effect; it may serve as a safe and effective supplementary measure for thermal ablation of various neck nodular lesions.
ABSTRACT
In the Third world countries, the occupational health of a Reconstructive Surgeon attracts due attention from the applied physiology fraternity, where the massive amount of surgical workload causes chronic fatigue and repeated stress and injury. The knowledge of human physiology and the science of ergonomics analyze these challenges and formulate guidelines for creating a work environment that is safe and comfortable for its operators. Presented here is an innovative, cost effective, sterilizable, manually controlled hydrodissection instrument for surgery. This easy to make Syringe Pressure Gun (SPG), has revolutionized the face of cleft palate surgery reducing the surgical time to 50% and the palatal fistula rate from 3% to Zero percent. The effects were studied on patients and the operating surgeon both. The experimental group comprising of 1500 cleft palate patients in whom the gun was used during surgery as compared to 500 controls showed statistically highly significant results in terms of reduction in average bleeding in millilitres (P<0.05), average operating time in minutes (P<0.001), palatal fistula formation (P<0.005) and reduction in surgical complications like flap necrosis. The results in the operating surgeon (self control) on using the instrument, showed highly statistically significant fall in the muscle strain induced by tedious surgical manoeuvres, as studied by EMG (P<0.005), subjective hand grip pain and tiredness on a scale of 0-10, high convenience in flap dissection and therefore work performance improved in spite of the high volume of surgery. This ergonomic innovation will provide clues for future inventions based on physiological principles for improving the occupational health of the doctors and outcome of the patients.
ABSTRACT
We rotated the nucleus up to 270 degree and dislocated it into anterior chamber through the diameter of capsulorhexis after hydrodissection by using the planned extracapsular cataract extraction. And later on we delivered the nucleus with hydroexpression using the irrigating Vectis or with rotation using a lens spatuala. As a result of this procedure, the nucleus was safely delivered in all cases without zonular rupture and vitreous prolapse.