ABSTRACT
A new microsurgical instrument, the surgical pocket, is described, and its value for storing instruments in the surgical field during operation is discussed. Specific procedures for using the pocket in the field with the bipolar coagulator, suction irrigator, dissector, and scissors are presented. Proximity storage of microsurgical instruments reduces the surgeon's reliance upon other surgical personnel by allowing instrument transfers to be made without assistance. In addition, it reduces stress and fatigue for the surgeon by shortening the length of the operation and reducing eye strain by reducing the need to shift vision from the eyepieces of the microscope to the operating room and back each time an instrument is exchanged.
Subject(s)
Ergonomics , Microsurgery/methods , Neurosurgery/methods , Humans , Microsurgery/instrumentation , Neurosurgery/instrumentationABSTRACT
An intraoperative technique for deep brain biopsy is described. It features the use of an integrated surgical support system for the instruments and a rod that provides external topographical maintenance of the coordinates established ultrasonographically. A cystoscope, when supported mechanically by this system, permits multiple entries of the biopsy forceps to the lesion without further disturbance of the brain, as well as irrigation, coagulation, and visualization, if desired. When used in conjunction with real time intraoperative ultrasonography, the surgeon may view the entire procedure and be certain that the biopsy sample has been obtained from the lesion, major deep blood vessels have been avoided, and the biopsy site is stable after the procedure. The advantages of this technique include simplicity, low cost, accuracy, stability, and availability to every neurosurgeon in every hospital.
Subject(s)
Biopsy/instrumentation , Brain Neoplasms/surgery , Cystoscopes , Ultrasonography/methods , Aged , Biopsy/methods , Brain Neoplasms/pathology , Humans , Male , Ultrasonography/instrumentationABSTRACT
The author describes a technique providing mechanical rather than manual support to a suction tube for improved control of aneurysm hemorrhage during operation. This results in increased precision, fewer hand movements, reduced reliance upon other operating room personnel, decreased trauma to tissues as a result of multiple manipulations, reduced anxiety for the surgeon, and a shorter operating time.
Subject(s)
Intracranial Aneurysm/surgery , Intraoperative Complications/therapy , Suction/instrumentation , Humans , Microsurgery/methods , Rupture, SpontaneousABSTRACT
The use of mechanical support for scissors during microsurgery reduces tremor and improves the surgeon's efficiency. Rotation of such a pair of mechanically supported scissors presents further improvements as it permits the surgeon to cut in all directions while reducing the need for time-consuming instrument transfers. Thus, one pair of scissors can be kept within the field and rotated to the required orientation for cutting.
Subject(s)
Microsurgery/methods , Surgical Instruments , Humans , Microsurgery/instrumentation , Rotation , Surgical EquipmentABSTRACT
Computed-tomography cholangiography was used to evaluate the abdomen of 97 patients. The gallbladder and/or biliary tree was visualized well in 84 patients (87%); the distal common bile duct (CBD) was visualized well in 68 patients (70%). For 26 patients (30%) from the latter group, visualization of the opacified CBD was essential in order to differentiate the pancreatic head from the duodenum. Measurements of the distal CBD showed a significant difference between patients with gallbladders (mean, 4.7 +/- 1.2 mm) and those without gallbladders (mean, 6.8 +/- 1.1 mm). By visualizing the CBD and the superior mesenteric vein, exact dimensions of the uncinate process can be obtained. Also, the pancreatic head can be assessed more accurately, and the distal biliary tree can be evaluated.
Subject(s)
Cholangiography/methods , Common Bile Duct/diagnostic imaging , Pancreas/diagnostic imaging , Tomography, X-Ray Computed , Female , Humans , Male , Middle Aged , Technology, RadiologicABSTRACT
A new technique of mechanical support for microinstruments of action (e.g., scissors and air turbine drills) is presented. The technique consists of attaching instruments to ball and cable retractor arms (Flexbars) and securing them to a framework around the operative site. By assigning functional levels for instrument and hand placement, surgical procedures are simplified and shortened. A brief comparison of self-retaining retractors and an evaluation of them in terms of this technique is also included.
Subject(s)
Microsurgery/instrumentation , Neurosurgery/instrumentation , Surgical Equipment , Humans , Microsurgery/methods , Neurosurgery/methods , Surgical InstrumentsABSTRACT
A system for self-retaining retraction that has also been used as part of a technique of dissection in microneurosurgery is described. Small, multiple (i.e., more than two) blades can be used easily with a positioning opportunity of 360 degrees of purchase and without the necessity of another surgeon. Hand tremor, which is not particularly during microsurgery, has been dealt with by the development of a system for stabilization by a handrest. The components of the system, its sequential assembly, and its use are described and illustrated.
