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Instruments and Implants in Hand Surgery
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Anil K Bhat, Ashwath M Acharya, Mithun Pai G
Microsurgery requires specific instruments to handle delicate vessels without inducing trauma. These instruments are essential right from the dissection of individual vessels from the pedicle to their preparation for anastomosis to an actual anastomosis (Figures 15.34–15.36) [2].
What is difference in management of primary lymphedema between adults and children, and how much?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Cristobal M. Papendieck, Miguel A. Amore
Microsurgery can be performed in the pediatrics patient population. But the main concern is based on a fact that a vessel of these sizes can provide variable degrees of the transport capacity of that system. It would be necessary to do many anastomoses and also to consider performing it on malformed vessels if it is technically feasible, or with a deficient muscle (leiomyomatosis). The lymph node–vein anastomosis can be done, but the drawback is to achieve a lymphovenous pressure gradient that remains persistent in time at the level of the anastomosis. The vascularized lymph node transfer is also technically possible and also useful, but it is risky or insufficient if the lymphatic pathology is a systemic condition.1, 5–7
Fundamental Techniques Of Microvascular Anastomosis
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Microsurgical techniques require of us the application of Halsted’s surgical principles — “Gentle handling and exceedingly accurate approximation of tissues are of paramount importance” — to the small structures of the human body. Microsurgery is essentially divided into three fundamental techniques: microdissection, microvascular, and microneuro-surgery. Among these, microdissection is the most basic technique in handling small blood vessels and nerves. By the meticulous combination of these three techniques, microsurgery is now widely applied in several surgical disciplines.
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.
The future of virtual reality in cataract surgical training
Published in Expert Review of Ophthalmology, 2020
Daniel Josef Lindegger, Nouf Alnafisse, Ann Sofia Skou Thomsen, Abison Logeswaran, George M. Saleh
Microsurgery is a highly technical skill, taking years to master in an ergonomically challenging environment (requiring all four limbs to function independently), all whilst using an indirect viewing platform [45]. The backbone of current surgical education is still the mentor-apprentice Halstead model, and this will remain albeit with significant enhancements [46]. Transformational changes to cataract surgical tutorage, and the virtual reality technology deployed to enhance it, will emerge in the near future [47,48]. Facilitated by accelerating developments in this sphere, these technologies will, in our opinion, offer a rapidly improved array of skills acquisition options, in a personalized fashion, delivered flexibly and remotely, reflecting a deeper understanding of modern learning theories.
Data analytics interrogates robotic surgical performance using a microsurgery-specific haptic device
Published in Expert Review of Medical Devices, 2020
Amir Baghdadi, Hamidreza Hoshyarmanesh, Madeleine P. de Lotbiniere-Bassett, Seok Keon Choi, Sanju Lama, Garnette R. Sutherland
The design specifications of neuroArmPLUSHD are described previously by Hoshyarmanesh et al. [24,25]. In brief, neuroArmPLUSHD is a haptic hand-controller with (7 + 2) degrees-of-freedom (DOF) positional sensing (average resolution: 0.06 deg; accuracy: 0.9 mm), 3 DOF force feedback (peak force: 15 N; force resolution in x, y, and z directions: 0.1 N, 0.35 N, and 0.3 N), a large dexterous workspace (translational: 850 × 830 × 1312 mm; rotational: 180 × 160 × 180 deg.) and weight of 35 kg designed specifically for microsurgery (Figure 1). An actuator is incorporated at the tip in order to convey force interactions in the surgical environment. The hand-controller is designed to recreate the act of performing surgery with an anthropometry-driven structure mimicking the human upper extremity, i.e. serial linkage design in order to maximize the device intuitiveness and dynamic weight compensation to avoid interference of the device with natural arm movement. Furthermore, in microsurgery it is imperative to accurately perceive, plan, and execute the act of fine surgical tasks, e.g. pinching/grasping, dissection forces, and tool roll. Accordingly, the pitch, roll, and yaw of the handpiece end-effector are optimized in order to reflect the movements required by a surgeon’s hand [30]. In spite of the existing haptic devices that have generic multifunctional handles without considering the tool specifications suitable for executing the desired surgical tasks, neuroArmPLUSHD modular handle incorporates microsurgical instruments (Figure 1).