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Other Support Surfaces
Published in J G Webster, Prevention of Pressure Sores, 2019
In order to accommodate the optimal surgical access and to obtain proper physical support, the operating table is adjusted to various surgical positions. The specific weight-bearing regions are at risk of pressure sore formation. In fact, the standard operating table that is constructed with a 25–50 mm foam mattress offers little protection to anesthetized patients.
Case 97
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
Hearing: bone-conducting or bone-anchored hearing aids (BAHAs) work well as the hearing loss is often mostly conductive. (The surgical position of the BAHA should be sufficiently posterior to allow for future reconstructive surgical options.)
Surgery for the Enlarged Thyroid
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Neeraj Sethi, Josh Lodhia, R. James A. England
The Swiss anatomist Haller first described the finding of a thyroid with intra-thoracic extension in 1749.10 The first report describing removal of such a thyroid was by Klein in 1820.11 Intra-thoracic, secondary intra-thoracic, substernal and cervicomediastinal are all terms that have been used synonymously with retrosternal. Up to ten definitions for these are found in the literature with the most commonly used being either (i) any goitre which extends below the thoracic inlet (with the patient in the surgical position) or (ii) any goitre where more than 50% of the gland is below the thoracic inlet.12-21 Primary intra-thoracic goitre is a distinct entity and describes a thyroid mass that originates from ectopic thyroid tissue in the mediastinum, rather than from cervical thyroid tissue.22
Perinatal outcomes of twin emergency cerclage: comparison with expectant treatment and singleton emergency cerclage
Published in Journal of Obstetrics and Gynaecology, 2023
Yuanfan Lu, Jing Zhu, Xiaoting Yu, Zhenyao Li, Tong Zhou, Jiajia Chen, Xianping Huang, Huiqiu Xiang, Jiale Bao, Zhangye Xu
Emergency cerclage was performed under lumbar anaesthesia by experienced physicians. The surgical position was the bladder lithotomy position. All patients received prophylactic antibiotics, such as cefuroxime, cefazolin and azithromycin, before and 2 days after surgery. Intraoperative exposure of the cervix was performed using a speculum. If the amniotic sac was protruding out of the cervix, a catheter water sac was used to push the amniotic sac back into the uterine cavity, according to the size of the protruding amniotic sac. The anterior and posterior lips of the cervix were clamped with cervical forceps and the cervix was sutured around the circle using the Johnson & Johnson D8438 suture needle and thread [using the McDonald technique (Locatelli et al.1999)]. The catheter balloon was removed before tying the knot. Routine post-operative bed rest, avoidance of strenuous exercise and contraction inhibitors (ritodrine) were administered for 2–5 days to prevent infection. The dosage of contraction suppressants was adjusted according to maternal contractions and discontinued if the contractions could not be suppressed or an intrauterine infection was suspected.
Intraoperative AIRO mobile computer tomography in frameless stereotactic procedures
Published in British Journal of Neurosurgery, 2022
Marco Riva, Umberto A. Arcidiacono, Matteo Gambaretti, Lorenzo G. Gay, Tommaso Sciortino, Marco Rossi, Marco Conti Nibali, Lorenzo Bello
A head CT scan was performed intraoperatively (AIRO, Brainlab AG; axial scan, 1 mm slice thickness, X-ray voltage 169.6 mA, kV 120.0, mA/s 325.6). The intraoperative CT (iCT) scan was obtained upon the following surgical indications: to rule out acute complications, to enable image fusion with preoperative MRI, to assess the correct placement of the biopsy needle before the sampling, to verify the drainage needle and the proper drainage of a cystic lesion. Following the surgeon’s indication, maintaining the surgical position, the mobile radiolucent bed is rotated manually of 90° to be accommodated into the sliding iCT bore. The iCT is obtained and transferred to the navigation platform. iCT scan was performed 100 s after complete contrast administration when employed. The surgery is then resumed rotating the bed back to the original position.14 The time between the surgeon’s indication and the resume of surgery was 15.2 ± 3.1 min.
Patient and physician positioning during anterior skull base surgery impacts physician ergonomics
Published in British Journal of Neurosurgery, 2022
Pavithran Maniam, James Lucocq, Rohit Gohil, Giles Lewis-Morgan, Ashok Rokade
Two-surgeon, four-hand anterior skull base surgery was simulated in a clinical room, focusing on a constant lesion at the pituitary sella. A total of 20 different surgical positions involving the operating surgeon (Surgeon 1), assisting surgeon (Surgeon 2), patient head position, camera position and screen position/number were simulated (Table 1). For example, in position 1, surgeon 1 is positioned to the right of patient, surgeon 2 is positioned to the right of patient, the patient’s head is turned to the right, the camera is held by surgeon 1 and one screen is positioned to the left of patient (Figures 1–3). The two primary authors acted as surgeons 1 and 2, respectively. A volunteer acted as the patient. An endoscopic camera head was used to signify the rigid nasal endoscope whilst the other instruments held by both surgeons were simulated using disposable suction handpieces. For each of the twenty positions, the desired arrangement was held in a static position and filmed. Subsequently, the different positions were reviewed, and the ergonomic effects were analysed using the Rapid Upper Limb Assessment (RULA) tool. Surgeons 1 and 2 were of the same height to limit any additional ergonomic effects related to this discrepancy. The table height was also kept constant.