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Special Care Units
Published in William C. Beck, Ralph H. Meyer, The Health Care Environment: The User’s Viewpoint, 2019
The specialties of surgery are becoming so complicated, and new operations are being performed by a variety of specialists, so diverse, that specialized operating rooms are, in general, going out of use. Furthermore, the same technical equipment used by each of the specialists is now more and more being adopted by other specialists than those who had originally devised them. Not too many years ago, the operating microscope was used only by the otologist to perform some of the miniature operations upon the ossicles of the ear. Today the operating microscope has been adopted by the neurosurgeon, the eye surgeon, the orthopedic surgeon, the plastic surgeon, and, in fact, by almost all who are suturing fine blood vessels or very small structures.
Fundamental Techniques Of Microvascular Anastomosis
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
To perform microvascular anastomosis an operating microscope, special microinstruments such as a needle holder, scissors, forceps, micro-double-clip, and fine suture materials are essential. Although loupes with 2 to 4 × magnifications mounted on a spectacle frame can be used for performing fine surgery such as hand or plastic surgery, they present several disadvantages: a short working distance, a narrow visional field, fixed and very low magnifications, as well as a resulting stiff neck for the surgeon. On the contrary, an operating microscope is designed to provide changeable magnifications, a better illuminating system, and a comfortable working distance. Zeiss® operating microscopes — OPMi-1 and 6 — have been used by us for many years for experimental and clinical microsurgery, but recent models of a two-man microscope, the OPMi-6 FD and 7 with a focal distance of 200 mm, are much more suitable for performing microsurgery in the fields of orthopedic and plastic surgery.
The Autologous Vein Grafts in Reconstructive Microsurgery for Lymph Stasis
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
For suturing we use monofilament nonabsorbable material, 8-0/9-0, with atraumatic needle with circular section. The magnifications used at the operating microscope during the different phases of the operation are 15 to 40 ×.
Gross total resection with fluorescence could lead to improved overall survival rates: a systematic review and meta-analysis
Published in British Journal of Neurosurgery, 2022
Alexandrina S. Nikova, Penelope Vlotinou, Loukas Karelis, Michael Karanikas, Theodossios A. Birbilis
Surgical resection is typically performed using an operating microscope with or without fluorescence usage. Fluorescence could help observe a tissue containing tumour that is otherwise not apparent and, therefore, may allow the performance of extended resection.4–6 Especially, the improved visualization achieved after using fluorescence labeling enables more complete resection of surgical disease, while protecting adjacent vital structures. Fluorescence is obtained with 5-aminolevulinic acid (5-ALA) or fluorescein sodium (Fl-Sodium). Especially, 5-ALA is a compound of the heme-metabolism pathway. It is metabolised into a fluorescence substance and protoporphyrin IX and, then, into a non-fluorescence material– heme. Moreover, it is orally administered a few hours before surgery. It crosses the blood-brain barrier and could visualise the tumour.7,8 During surgery, the fluorescence strength varies from case to case and place to place in the same case.
COVID-legal study: neurosurgeon experience in Britain during the first phase of the COVID-19 pandemic – medico-legal considerations
Published in British Journal of Neurosurgery, 2021
Roisin Finn, Mario Ganau, Michael D. Jenkinson, Puneet Plaha
Level 2 PPE has brought its challenges with new equipment (masks, visors etc.), ‘donning’, ‘doffing’ and new theatre protocols.7 Almost a quarter (23%) of neurosurgeons reported struggling to access appropriate PPE for suspected or confirmed COVID-19 cases. A big challenge for surgeons was the physical aspect of wearing higher levels of PPE during the surgery. As expected, most surgeons reported difficulties with eye protection (visor/googles) and FFP3 face masks or respirators. This protective gear was particularly challenging when surgeons were using the operating microscope/surgical loupes as the eye protection and some of the face masks are not designed for microscope/loupes use. Donning an additional gown/apron and another pair of gloves, as well as the FFP3 masks, made surgeons more likely to suffer from headaches, experience more fatigue than normal and ‘overheat’. The guidance for Level 2 PPE for neurosurgery has since been revised and apart from nasal passage related procedure (e.g. trans-sphenoidal pituitary surgery) other neurosurgical procedures are now considered safe including bone drilling.6 Therefore, in majority of neurosurgical units in the UK surgeons now do not wear full level 2 PPE for SARS-CoV-2 negative patients planned for elective surgery. However, the difficulties faced by surgeons using level 2 PPE at surgery need to be made known to NHS hospital trusts and suppliers of PPE equipment so that existing designs can be modified to suit the needs of neurosurgeons when they are dealing with suspected or confirmed COVID-19 cases.
Microsurgery in the era of COVID-19
Published in Baylor University Medical Center Proceedings, 2021
Jesse I. Payton, Stacy Wong, Nicholas F. Lombana, Michel S. Saint-Cyr, Andrew M. Altman, Sebastian M. Brooke
Inherent in the plastic surgeon is the ability to innovate in the face of challenges. In order to safely operate in the setting of high-risk reconstruction, adaptations to the standard microsurgery procedure may be considered. Use of sealed eye protection with the operating microscope has been feasible in our hands (Figure 3) with use of anti-fog solution to improve visibility. As closed eye protection can fog despite anti-fog, this limits the time available for microsurgery. This means that residents may perform less microsurgery, which ultimately may have an impact on resident education. If operating with a microscope that conveys high-definition video, one may consider use of the monitor to perform microsurgery in lieu of the eyepieces (Figure 4). Before the COVID-19 pandemic, transoral robotic surgery was gaining widespread use among head and neck oncologic and reconstructive surgeons,30 with outcomes comparable to those of nonrobotic anastomoses with use of a standard operating microscope.31 This would allow spatial segregation of the operating surgeon from the high-risk field.