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Bone Conduction and Middle Ear Implants
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Percutaneous surgery can be carried out through a linear incision or a minimally invasive technique (Figure 13.1). Skin thickness is measured to enable the appropriate choice of abutment length. A hole is drilled in the skull and then widened/finished with a ‘countersink’ burr. The combined implant abutment is then screwed into the skull hole to a specified tightness (measured with a torque wrench). For Baha Attract surgery the technique is similar to open percutaneous surgery. The same implant/screw that osseointegrates into the skull is used, but the BIM400 implant magnet is attached to the screw rather than an abutment (Figure 13.2). In Bonebridge surgery the implant is embedded and screwed into the skull in an appropriate position behind the ear.
Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Preoperative workup traditionally included formal diagnostic angiogram, however that has largely been replaced by noninvasive axial imaging, including CTA or MRA to delineate the extent of the disease. The Trans-Atlantic Intersociety Consensus (TASC II) document has helped dictate first-line therapy depending on extent of disease. Percutaneous balloon therapy is often sought as first-line therapy in patients with TASC A or B lesions (focal, short segment lesions 3–10 cm, unilateral or bilateral). Open revascularization is generally reserved for those with long segment occlusions or diffuse disease.1 With the advancement of endovascular techniques and equipment, aortobifemoral bypass (ABF), which had long been considered the gold standard for aortoiliac occlusive disease, is increasingly now reserved for more complex patients. This impact has been two-fold in consideration of perioperative complications: surgeons are performing a lower volume of open surgery, and those surgeries are reserved for patients with more demanding anatomy, often in the setting of previous percutaneous failure. This trend in the management of aortoiliac occlusive disease makes awareness of the complications of ABF of the utmost importance for any surgeon performing this procedure, to both mitigate the risk and appropriately identify and manage any complication that may occur.
Fetal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Emily A. Partridge, Alan W. Flake
When first developed in the 1970s, fetoscopy functioned as a diagnostic tool, but it has since become a tool for minimally invasive fetal interventions with the development of more advanced camera equipment and endoscopic devices. Fetoscopy has similar complications to open fetal surgery, including bleeding, preterm premature rupture of membranes, preterm labor with delivery <32 weeks, chorioamniotic separation, and chorioamnionitis. The risk of fetoscopic complications correlates with the size of the fetoscope, the number of trocar sites, and the length of the procedure. For simple procedures, the risk of preterm labor is lower than open fetal surgery. The procedure can generally be performed percutaneously under local or regional anesthesia. However, any procedure that would potentially cause fetal pain should include intramuscular injection of an opioid and a paralytic agent for fetal anesthesia.
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
There are several methods by which a Tenckhoff catheter can be placed inside the peritoneal cavity, including a variety of open surgical techniques, laparoscopic surgery, and percutaneous insertion [7]. Surgical and laparoscopic methods usually require a general anesthetic and are mostly performed by surgeons. The advantage of these procedures is that they allow direct visualization of the peritoneal cavity and usually lead to better catheter position and relatively less risk of catheter migration. Laparoscopic techniques also allow for the catheter to be stitched into the pelvis, which avoids catheter migration and reduces the risk of inadequate dialysis. Lysis of intraabdominal adhesions can also be performed during catheter placement if present. The percutaneous technique can be performed either by a surgeon or a physician under local anesthetic. This technique is more suitable for elderly patients who may not be at high risk of complications from general anesthesia. Complications associated with PD catheter insertion include bowel perforation, more common with percutaneous technique, serous and dialysis fluid leaks, hemorrhage, and catheter malfunction due to dislocation. Infections such as peritonitis and infection around the catheter exit site may also occur and the risk of infections can be reduced by administration of pre – procedure antibiotics [8].
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Left renal vein stenting in the management of the NCS has shown some efficacy in the treatment of PCS caused by this syndrome. However, there are few studies with small numbers of participants [118,119]. Stenting of the left renal vein is associated with a high risk of migration to the vena cava and the heart due to short vein length and change in vein diameter when the patient changes position or performs the Valsalva manoeuvre [120]. Left renal vein transposition is not always successful and it is correlated with serious complications like bleeding, thrombosis, kidney injury or infection [42,118]. In 2020 Gilmore et al. reported gonadal vein transposition in 18 patients, with complete symptom relief in 11 patients (61.1%) after a median follow-up of 178 days [121]. Complications of percutaneous embolisation are usually rare and harmless. These include recurrence of symptoms, haematoma at the puncture site, allergic reaction, embolic agent migration or coil erosion [78,122,123].
It’s the Destination, Not the Journey: Surgical Deployment of Percutaneous Devices
Published in Structural Heart, 2021
For transcatheter structural heart technologies to be successful, they must meet thresholds of efficacy and durability, with low complication rates as well as deliverability via either the venous or arterial system, thus significantly limiting device size. The mode of action of these percutaneous devices can be refined iterations of surgical devices (transcatheter aortic valve replacement), can mimick surgical techniques (the MitraClip replicating the Alfieri stitch), or can be developed to achieve the same result via a different mechanism (preventing access to the left atrial appendage (LAA) using occlusive devices (occlusion vs suturing or ligation)). Many percutaneous devices have features that can be valuable in an open procedure beyond traditional surgical techniques. The ability for procedural optimization with direct visualization and access to the device is a unique potential benefit for the surgeon to exploit.