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Novel Injection Techniques
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana
Dissection is the part of the procedure that results in tissue destruction. Unwanted events occur during this step. In some critical parts of the face – the forehead, for example – even the advancement of the cannula by hand is not free of risk. A more rigid cannula sometimes cannot follow the curved surfaces and might change its plane more toward the superficial or deeper layer where vessels or nerves can be encountered. The latter can cause a substantial amount of pain and should be avoided (Figures 4.3 and 4.4). However, a flexible cannula can advance more unpredictably into the facial soft tissues, posing an equal risk to the patient. It is not easy to make direct injection on the forehead even, complete and within a single layer. With these concerns, using saline instead of these instruments for the part of dissection is a wise idea (Figures 4.5 and 4.6a–d).
Head and neck surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
During dissection of the first branchial cleft cyst, care must be taken to avoid damage to the adjacent facial nerve in cases where there is a tract leading up to or into the external auditory meatus (Figure 2.8). The deep or superficial lobes of the parotid gland may need to be mobilized or occasionally the superficial lobe may need to be resected if the tract extends deeply. A neurosurgical nerve stimulator is often helpful during the dissection. Tracts that extend toward the external auditory canal may require removal of the skin and cartilage components of it.
Laparoscopic-Assisted Stomas and Stoma Reversal
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
There are several adjuncts that may be of assistance during the laparoscopic dissection. If difficulty is encountered, a hand-assist device may be placed at the stoma site, as a bridge to converting to open surgery. In many cases, the vagina or bladder will become adhered to the rectal stump. Identification of the correct tissue planes may be enhanced by placing a dilator in the rectum or vagina, or filling the bladder with saline. Prior to anastomosis, if the original pathology was diverticular disease, any remaining sigmoid colon must be resected.
Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone® Cranioplasty: an appealing surgical rendez-vous
Published in British Journal of Neurosurgery, 2023
F. Graziano, R. Maugeri, G. R. Giammalva, E. Lo Bue, G. Zabbia, D. G. Iacopino
Prior to placement of the custom-made prosthesis, a careful skin and subcutaneous flap dissection is performed in order to expose entirely the bone margins. Care is taken to recognize, respect and preserve each tissue layer and in particular the duroplastic thin layer covering the inner surface of the brain. Traditionally, this surgical manoeuvre is performed through the scalpel and the scissor. Despite it’s technically feasible and not demanding in an experienced and delicate hand, it’s a time consuming technique. Sometimes it is more indicate dissecting through the non-cutting upper side of the scalpel, sometimes through the scissor, and in cases of bleeding vessels, it’s necessary to change the instrument with the bipolar coagulation forceps. During these manoeuvres there could be the risk to cut or tear the thin dural layer and potentially to damage the underlying cerebrovascular structures. At the end of the dissection, the bone margins are eroded in order to promote new bone formation and osseointegration. Finally, the prosthesis is fixed by non-resorbable suture material (Figure 2). Being CustomBone® prosthesis made of HA they may prone to attract liquid material through an osmotic mechanism, inducing a temporary hematoma formation in the subgaleal or in the epidural spaces. Neurosurgeons are aware of this potential event and normally a subgaleal drain is placed for around 48 h to reduce the formation and duration of the subgaleal hematoma. Conversely, epidural formation usually re absorbe spontaneously within few days.
A chronicle of the pancreatoduodenectomy technique development – from the surgeon’s hand to the robotic arm
Published in Acta Chirurgica Belgica, 2023
Marek Olakowski, Beata Jabłońska, Sławomir Mrowiec
The first robotic surgery platform introduced to the global market was Intuitive Surgical’s DaVinci system. It consists of a three-armed robot that is operated by a surgeon sitting at a separate console. This platform overcomes many of the key disadvantages of traditional laparoscopy, which include monocular vision, limited degrees of freedom and pivot and fulcrum effects (reversal of action at the trocar pivot point) that make complex surgical tasks difficult to perform. In contrast, the robotic approach provides the surgeon with a three-dimensional, stereoscopic view of the surgical field and restores hand-eye coordination. The Endowrist instrumentation imitates human hand movements with seven degrees of freedom and eliminates hand tremor. The ease and precision of dissection and suturing using the robotic platform represents a real advance over the traditional laparoscopic approach. However, the robotic method is not without its drawbacks. For example, robotic operators consistently report the lack of haptic feedback as a disadvantage, which can lead to excessive tissue or suture material tension during suture fixation. The initial capital cost of a robotic platform, depending on its equipment, is $1–2.5 million, with annual costs to operate the device exceeding $100,000 [40].
A Large Segmental Mid-Diaphyseal Femoral Defect Sheep Model: Surgical Technique
Published in Journal of Investigative Surgery, 2022
David S. Margolis, Gerardo Figueroa, Efren Barron Villalobos, Jordan L. Smith, Cynthia J. Doane, David A. Gonzales, John A. Szivek
Reverse dynamization refers to the process of statically locking a device that was initially dynamized. The initial dynamization is accomplished though one of the methods described above. Reversal of this process occurs through placement of an interlocking screw through a proximal round interlocking hole, or through the outer part of the oblong hole near the end of the nail. Although technically demanding, the “perfect circle” method [20] is used to place the interlocking screws. In this process intraoperative fluoroscopy is used to mark the location and alignment of an interlocking hole by positioning a radiographic imager perpendicular to holes, resulting in a “perfect circle” (Figure 8c–e). A small incision can then be made, and blunt dissection used to access the bone. A soft tissue guide is used to assist with maintenance of drill alignment to ensure bi-cortical drilling of the femur through the interlocking hole. A 4.5 mm screw is placed after using a depth gauge to confirm screw length (32 mm is the typically length). When placing this screw, it is recommended to tie a loop of suture around the screw head to ensure easy retrieval if placement is difficult. Once the screw is partially inserted in the bone, the suture can be cut prior to fully seating the screw. Use of cannulated screws that allow for guidewire placement facilitate much easier placement and removal of interlocking screws.