Robotic harvest of the rectus abdominis muscle: a preclinical investigation and case report.
Creator
Patel Niyant V; Pedersen John C
Publisher
Journal of reconstructive microsurgery
Date
2012
2012-09
Description
In an attempt to decrease donor-site morbidity for rectus abdominis muscle harvest during free tissue transfer, we developed a technique of minimally invasive harvest. The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in two cadavers for dissection and harvest of four rectus abdominis muscles. After the cadaver dissections were performed, the technique was used in a 30-year-old woman to harvest the left rectus abdominis muscle for free tissue transfer to a lower extremity defect. Four cadaver dissections for harvest of the rectus abdominis muscle using the da Vinci Surgical System were performed. In the cadavers and actual case, three ports (11 mm, 11 mm, and 15 mm) were used to access the abdominal cavity and perform the dissection. An additional 3 cm incision was used to remove the muscle from the abdominal cavity. The patient has not developed any surgical-site morbidity, including bulge or hernia in the 6 months postprocedure. Minimally invasive harvest of the rectus abdominis muscle is possible with the assistance of the da Vinci Surgical System. Potential benefits may include decreased surgical-site morbidity. Also, this may provide an approach to minimally invasive transperitoneal reconstruction.
Subject
*Robotics; Adult; Cadaver; Dissection; Female; Free Tissue Flaps; Humans; Limb Salvage; Lower Extremity; Minimally Invasive Surgical Procedures; Muscle Neoplasms/*therapy; Rectus Abdominis/*surgery; Sarcoma/*therapy; Tissue and Organ Harvesting/*methods; Wounds and Injuries/*surgery
Maximizing patient satisfaction and functional results after total knee arthroplasty.
Creator
Greene Kenneth; Harwin Steven F
Publisher
The journal of knee surgery
Date
2011
2011-03
Description
The purpose of this article is to review the issues regarding preoperative patient expectations for total knee arthroplasty and whether or not these are fulfilled after surgery. The demographics of the typical total knee arthroplasty patient are changing, and the expectations regarding the outcome of the surgery have been changing as well. Patients are younger, heavier, more active, and often come to the surgeon's office with information provided via the Internet that may be inaccurate and/or misleading. Many expect and assume that the operation will return the knee to "normal." Traditional outcomes measures used by orthopedic surgeons to determine the quality of the results achieved are inadequate and do not take into account the higher expectations of current patients. Various strategies have been developed to improve satisfaction after the surgery. These include preoperative patient education, less invasive surgical approaches, advances in prosthetic design, multimodal pain management, and aggressive postoperative rehabilitation. Using these strategies will make preoperative expectations more realistic and improve postoperative satisfaction.
Laparoendoscopic surgery is fueled by technology, and advances in medical imaging may bring about further progress. The application of three-dimensional ultrasound to minimally invasive surgery represents technology "just over the horizon." This article describes the scientific basis of three-dimensional ultrasound and its ability "to see" anatomy not readily visualized laparoscopically. Three-dimensional ultrasound may offer a more intuitive, accurate assessment of hidden anatomic structures in real time, using a safe, non-ionizing and cost-effective technology.
Subject
Cost-Benefit Analysis; Data Display; Humans; Interventional/economics/methods; Laparoscopy; Medical Laboratory Science/economics/methods; Minimally Invasive Surgical Procedures; Ultrasonography; Ultrasonography/economics/*methods
Appendicitis in the elderly: a change in the laparoscopic era.
Creator
Paranjape C; Dalia S; Pan J; Horattas M
Publisher
Surgical endoscopy
Date
2007
2007-05
Description
BACKGROUND: Appendicitis in elderly patients is associated with significant morbidity and mortality. Early and correct diagnosis together with minimally invasive surgery can lead to more favorable outcomes than occurred in the prelaparoscopic era. METHODS: A retrospective review of 116 elderly patients (age \textgreater 60) from 1999 to 2004 is compared with the authors' previously published studies from 1978 to 1988 (n = 96) and from 1988 to 1998 (n = 113), respectively. RESULTS: In our current series (1999-2004), more cases were managed laparoscopically (n = 68) than with open surgery (n = 48). Perforated appendicitis cases resulted in significantly longer hospital stays, more complications, and longer operating time than nonperforated cases. The laparoscopic cases had significantly shorter lengths of hospital stay and fewer complications than open cases, and comparable operating times. As compared with our previous studies from 1978 to 1988) and from 1988 to 1998, the current series (1999-2004) consists of patients presenting with fewer classical symptoms. Computed tomography (CT) scanning was more accurate in the current study and more routinely used. The patients in the current series had more correct preoperative diagnoses. Perforated appendicitis was encountered less frequently and associated with fewer complications. The 4% mortality rate in the previous two series decreased to less than 1% in this series. CONCLUSION: Minimally invasive surgery combined with increased use and accuracy of preoperative CT scans has changed the clinical management of acute appendicitis in elderly patients, leading to decreased lengths of stay, decreased mortality, and more favorable outcomes.