Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications.

A motor-driven artificial pump and its transcutaneous energy transmission (TET) system are discussed. The artificial pump consists of a high-speed DC brushless motor driving a ball screw and magnetic coupling mechanism between the blood pump and ball screw. The ball screw transfers high-speed rotary motion into low-speed rectilinear motion by a single component. Magnetic coupling enables active blood filling without applying an excess negative pressure to the pump. The transcutaneous transformer is formed from a pair of concave/convex ferrite cores. This design minimizes lateral motion of the external core. Information on motor voltage is transmitted through the skin by infrared pulses. The motor voltage is regulated by controlling the duty ratio of the square pulse supplied to the primary coil. Pump flow of 5.6 l/min was obtained with a mean outlet pressure of 100 mm Hg at a drive rate of 100 b.p.m. under preload of 15 mm Hg. >

Development of an implantable motor-driven assist pump system

Although literature provides evidence regarding the superiority of surgery over conservative treatment in patients with lumbar disc herniation, recurrent lumbar disc herniation (RLDH) was the indication for reoperation in 62% of the cases. The major problem with revisional lumbar discectomy (RLD) is that the epidural scar tissue is not clearly isolated from the boundaries of the dura matter and nerve roots; therefore, unintended durotomy and nerve root injury may occur. The biportal endoscopic (BE) technique is a newly emerging minimally invasive spine surgical modality. However, clinical evidence regarding BE-RLD remains limited. We aimed to compare the clinical outcomes after performing open microscopic (OM)-RLD and BE-RLD to evaluate the feasibility of BE-RLD. This retrospective study included 36 patients who were diagnosed with RLDH and underwent OM-RLD and BE-RLD. RLDH is defined as the presence of herniated disc material at the level previously operated upon in patients who have experienced a pain-free phase for more than 6 months. BE-RLD was performed as follows: two independent surgical ports were made inside the medial pedicular line of the target segment and on the intact upper and lower laminas. Peeling off the soft tissue from the vertebral lamina helps to easily identify the traversing nerve root and the recurrent disc material without dealing with the fibrotic scar tissue. Clinical outcomes were obtained using a visual analog scale (VAS) and the modified Macnab criteria before and at 2 days, 2 and 6 weeks, and 3, 6, and 12 months after surgery. The data of 20 and 16 patients who underwent OM-RLD and BE-RLD, respectively, were evaluated. The demographic and perioperative data were comparable between the groups. During the year following the surgery, in the BE-RLD group, the VAS scores at each point were significantly improved over the baseline and remained improved up to 2 weeks after surgery (p 0.05). According to the modified Macnab criteria on the follow-up, the excellent or good satisfaction rates reported at 2 weeks, 6 weeks, 6 months, and 12 months after surgery were 81.25%, 81.25%, 75%, and 81.25%, respectively, in the BE-RLD group, and 50%, 75%, 75%, and 80%, respectively, in the OM-RLD group. BE-RLD yielded similar outcomes to OM-RLD, including pain improvement, functional improvement, and patient satisfaction, at 1 year after surgery. However, faster pain relief, earlier functional recovery, and better patient satisfaction were observed when applying BE-LRD. Retrospectively registered

/pdf/clinical-outcome-of-biportal-endoscopic-revisional-lumbar-1irkdfoefe.pdf

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation.

The latissimus dorsi (LD) flap is a common and useful tool for breast reconstruction that has many advantages, including safety and ease of use. However, seroma at the donor site is still the main complication after an LD flap procedure.1–3 A seroma is now thought to mainly comprise tissue fluids resulting from disruption of lymphatic vessels and inflammatory reactions in affected tissue caused by use of monopolar electrocautery (EC).1–5 We previously reported that use of Harmonic Focus shears (HFS) for LD flap elevation, instead of EC, reduced the lengths of the drainage period and hospital stay after surgery.3 However, we could not find evidence that HFS significantly reduced the incidence of seroma formation, and HFS also has a high cost.

The PEAK PlasmaBlade (PPB) is a new electrosurgical device that has lower cost and provides more atraumatic, scalpel-like cutting precision on skin, while the blade temperature stays close to body temperature and provides electrosurgical-like hemostasis, resulting in minimal tissue injury (Fig. ​(Fig.11).6,7 Therefore, there is a possibility that seroma formation can be significantly reduced using the PPB. The aim of this study was to evaluate the benefits of the PPB relative to conventional EC for tissue dissection, in terms of operation time, length of hospital stay, and complications, and to investigate the efficacy of the PPB for reduction and prevention of seroma in an LD flap procedure.




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Fig. 1.


The electrosurgical device and intraoperative pictures. A, The PPB (Medtronic Inc., Minneapolis, Minn.). Precise pulses of RF energy and proprietary insulation material on both sides of the blade enable the devise to dissect like a scalpel and control bleeding, while causing minimal thermal damage to surrounding tissue. B, Intraoperative image of skin incision. C, The dissection surface of the LD muscle using the PPB. RF, radiofrequency.

Preventive Effect on Seroma of Use of PEAK PlasmaBlade after Latissimus Dorsi Breast Reconstruction.

Comparison of tissue effects in rabbit muscle of surgical dissection devices

Multiple energy-based surgical dissection and coagulation modalities are available to facilitate surgical dissection and hemostasis, but there is limited information regarding the acute tissue effects of these devices. Our objective was to compare the functional characteristics and tissue effects of four energy-based surgical dissection and coagulation modalities on the rabbit liver. Linear incisions were created in the rabbit liver using monopolar electrocautery, a harmonic scalpel, a PlasmaBlade and a new ferromagnetic induction loop device. Subjective cutting and coagulation characteristics for each device were recorded, and the histological tissue effects were evaluated. Each of the modalities successfully incised the liver tissue. The PlasmaBlade and the ferromagnetic induction loop exhibited significantly less perceived tissue drag during the incision, significantly less collateral tissue damage and significantly better margin uniformity than the monopolar electrocautery device. Each device showed comparable subjective hemostasis. The harmonic scalpel did not demonstrate a significant difference compared with any of the other devices in any of the parameters examined. The histological analysis revealed that the least lateral thermal damage resulted when the PlasmaBlade, harmonic scalpel and ferromagnetic induction loop were used, and the most damage occurred with the use of monopolar electrocautery. Each of the newer energy-based surgical tools showed improvement over monopolar electrocautery with regard to lateral thermal injury, and the ferromagnetic induction device and the PlasmaBlade demonstrated superior surgical tissue handling characteristics to the monopolar electrocautery device.

Comparison of the effects of surgical dissection devices on the rabbit liver.

Vegetative endocarditis and thromboembolism are the two leading pathologic findings and causes of death in calves receiving total artificial hearts (TAH). Percutaneous access devices (PAD) for the pneumatic drive lines often become infected and may serve as the nidus of infection of the vegetative lesions. Observations of 80 calves living with TAHs revealed that most infections began at the dorsal surface of the PAD. Chronic skin ulceration or acute, traumatic avulsion can result in PAD separation from the skin and bacterial implantation. Evaluation of 58 necropsy specimens from calves with TAHs demonstrated improper flange positioning in 76% of the PAD and gross infection in 57%. A new implantation technique and design of PAD have resulted in better flange position and less irritation at the skin/device interface. Necropsies of 11 animals with the new PAD have shown a reduction in superficial infections.

Percutaneous Access Devices in Calves Receiving an Artificial Heart

Comparison of ferromagnetic induction and bipolar electrosurgery and suction in corticotomies in pig cerebrum.

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Comparison of tissue effects in rabbit muscle of surgical dissection devices

Comparison of the effects of surgical dissection devices on the rabbit liver.

Percutaneous Access Devices in Calves Receiving an Artificial Heart

Comparison of ferromagnetic induction and bipolar electrosurgery and suction in corticotomies in pig cerebrum.