Use of a novel drape 'tent' as an infection prevention control measure for mastoid surgery.

BACKGROUND: Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the 'Southampton Tent' and 'OtoTent'. OBJECTIVES: To evaluate the use of a novel drape 'tent' that has advantages over established 'tent' designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field. RESULTS AND CONCLUSION: During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape 'tent'. Use of this drape 'tent' had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.

Técnicas abandonadas en cirugía de columna / Abandoned techniques in spine surgery

En cirugía de columna, ciertos dispositivos y algunas técnicas quirúrgicas han sido abandonados por completo o se hallan en franco declive. Aunque empleados en miles de pacientes, dichos tratamientos no han demostrado una efectividad sólida y duradera y, ocasionalmente, asocian morbilidades inaceptables. Ejemplos de abandono son la quimionucleólisis, la discectomía percutánea, la discectomía por láser o los geles antifibrosis. Otras técnicas se encuentran en marcado retroceso como los dispositivos interespinosos o las prótesis discales lumbares. Generalmente una técnica se abandona por falta de efectividad, morbilidad excesiva, sustitución por otra técnica más eficaz y menos agresiva, por falta de comercialización o por prohibición de su uso. En las últimas décadas, la enorme presión comercial y una creciente demanda social han conseguido convencer a muchos cirujanos de columna para que empleen tratamientos no suficientemente sustentados por estudios sólidos ni avalados por el paso del tiempo, muchos de los cuales eventualmente se abandonan

In spine surgery, certain surgical techniques and devices are currently in marked decline or have been completely abandoned. Although used in thousands of patients, such treatments failed to demonstrate durable and sound effectiveness, and sometimes associate inacceptable morbidity. Chemopapain injections, percutaneous discectomy, laser discectomy or antiadhesion gels are examples of abandoned therapies. Some other techniques are in frank decline like implantation of interspinous devices or lumbar disc prosthesis. In general, a technique is abandoned due to inefficacy, excessive associated morbidity, substituted by another more efficacious and less aggressive technique, end of commercialization, or usage prohibition. In the last decades, a great commercial pressure plus an increasing social demand have managed to convince many spine surgeons to indicate treatments not sufficiently supported by scientific evidence nor consolidated over time, many of which are eventually abandoned

Technological Advances in Surgical Equipment in Exotic Pet Medicine.

Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.

[Digital technology in clinical surgery and rehabilitation]. / Tsifrovye tekhnologii v klinicheskoi khirurgii i reabilitatsii.

This article is devoted to a very actual and insufficiently imagine in the literature theme - innovation and digital technologies in clinical surgery and rehabilitation. AIM: To schow posibilities of modern digital and information technologies in clinical practice based on the experience of the Pirogov Center. MATERIAL AND METHODS: Analysis of experience in the application of innovative technologies, robotic surgery, intraoperative navigation computer, robotic systems in medical rehabilitation, integrated operating room, surgical video communication systems in service of those doing the Pirogov Center for the past 10 years. RESULTS: Shows the feasibility of the considered technologies in modern clinical practice clinics. CONCLUSION: The experience of the Pirogov Center indicates that the extensive use in clinical practice of modern health care facilities of the latest high-tech equipment in conjunction with the introduction of process automation and digital integrated technology management and medical-diagnostic activity is an essential reserve to increase the activity of providing specialized, including high-tech medical care, carrying out a variety of scientific and educational activities.

Los equipos quirúrgicos avanzados en los escenarios contemporáneos de acciones combativas / Advanced surgical teams in contemporary scenarios of combat actions

Introducción: con el uso de la plataforma de Servicios de Información Ebsco Host, se accedió a las bases de datos a texto completo Academic Search Premier y Medline Complete. Objetivo: revisar la información contenida en los Descriptores MeSH 2014 acerca de Forward Surgical Teams, Iraq and Afghanistan. De dicha búsqueda surgieron evidencias bibliográficas de la utilización, empleo y desarrollo de los Forward Surgical Teams de los Servicios Médicos de las Fuerzas Armadas Norteamericanas (Ejército de Tierra), Francia, Reino Unido y Finlandia. Métodos: se expone el modo de empleo y la sucesiva tendencia a su perfeccionamiento operacional y tecnológico durante las últimas guerras en Medio Oriente a propósito del despliegue de tropas norteamericanas y de la coalición de la ONU en la cruzada contra el terror liderada por los Estados Unidos de Norteamérica. Los aspectos reportados en el artículo se refieren a la composición, despliegue y utilización táctica de los Forward Surgical Teams, a la aplicación de diversos protocolos de diagnóstico y tratamiento para la recepción y manejo de las bajas sanitarias debido a las acciones combativas y el afrontamiento de la preparación del personal médico y de enfermería antes, durante y después del despliegue de la institución médica(AU)

Introduction: Using Ebsco Host Information Services platform, the full-text Academic Search Premier and Medline complete databases were accessed. Objective: Review the information contained in 2014 MeSH Descriptors about Forward Surgical Teams, Iraq and Afghanistan. From this search bibliographical evidences emerged of the use, employment and development of the Forward Surgical Teams of the Medical Services of the Armed Forces in United States of America (Army), France, United Kingdom, and Finland. Method: It is presented here the way of employment and the successive trend towards its operational and technological improvement during the last wars in the Middle East on the deployment of US troops and the UN coalition in the United States-led crusade against terror of North America. The aspects reported in the article refer to the composition, deployment and tactical use of the Forward Surgical Teams, to the application of various diagnostic and treatment protocols for the reception and management of health casualties due to combat actions and the coping of the preparation of medical and nursing personnel before, during, and after deployment of the medical institution(AU)

[Minimally invasive surgery and robotic surgery: surgery 4.0?]. / Minimalinvasive Chirurgie und "robotic surgery": Chirurgie 4.0?

Surgery can only maintain its role in a highly competitive environment if results are continuously improved, accompanied by further reduction of the interventional trauma for patients and with justifiable costs. Significant impulse to achieve this goal was expected from minimally invasive surgery and, in particular, robotic surgery; however, a real breakthrough has not yet been achieved. Accordingly, the new strategic approach of cognitive surgery is required to optimize the provision of surgical treatment. A full scale integration of all modules utilized in the operating room (OR) into a comprehensive network and the development of systems with technical cognition are needed to upgrade the current technical environment passively controlled by the surgeon into an active collaborative support system (surgery 4.0). Only then can the true potential of minimally invasive surgery and robotic surgery be exploited.

One year orthopaedic trauma experience using an advanced interdisciplinary hybrid operating room.

Hybrid operating rooms have been used successfully in several surgical specialties, but no data have been published for orthopaedic trauma. We present our one-year orthopaedic trauma experience using a hybrid operating room, which incorporates 3D fluoroscopic imaging as well as navigation capabilities. Data were compiled for a series of 92 cases performed in an advanced hybrid operating room at the level one trauma center in Ulm, Germany. All patients who had surgery performed using this operating room during the first year were included. Setup time and surgical complications using hybrid operating room were recorded and analysed. The hybrid operating room resulted in no higher rate of complication than expected from the same cases in a conventional operating room. The hybrid room did however allow the surgeon to confidently place implants for orthopaedic trauma cases, and was most advantageous for spine and pelvis cases, both minimally invasive and conventional. Further, appropriate reduction and implant position was confirmed with 3D imaging prior to leaving the operating room and obviated the need for postoperative CT scan. Based on our one-year experience, the hybrid operating room is a useful and safe tool for orthopaedic trauma surgery.

[Hybrid operation theatre from the point of view of cardiac surgery. The future for the heart team]. / Hybridoperationssaal aus Sicht der Herzchirurgie. Zukunft für das Herzteam.

Nowadays, increasing numbers of procedures jointly conducted by cardiac surgeons and cardiologists are performed as minimally invasive surgical procedures or interventions. Transcatheter aortic valve implantation, endovascular aortic aneurysm repair and a large variety of hybrid procedures for congenital heart disease have become current standards. Some of these hybrid procedures were shown to improve the therapeutic safety and efficacy, effects particularly true for high-risk patients and complex interventions. Hybrid procedures require indirect imaging, commonly provided by an angiography system in the hybrid operation theatre. This article describes the technical prerequisites required for a hybrid operation theatre as well as indications and rationales for hybrid procedures conducted in this environment. It is likely that the indications for cardiovascular hybrid procedures will continue to be expanded and that the hybrid operation theatre may become a laboratory for developing innovative approaches in the cardiovascular field. Therefore, the hybrid operation theatre will not only be the working environment for hybrid surgeons and interventionalists but also help to evolve their future.

[Hybrid operation theatre in vascular surgery. Options and perspectives]. / Hybridoperationssaal in der Gefäßchirurgie. Möglichkeiten und Perspektiven.

BACKGROUND: Demographic development leads to an increase in vascular interventions due to the increase in elderly and multimorbid patients. The aim of this study was to demonstrate the open interventional therapy options and their influence on staff and patients which have become possible due to the introduction of angio-hybrid operations including 3-D imaging Dyna-CT. MATERIAL AND METHODS: The modifications with respect to radiation protection for staff, improvements for patients and the possibilities of operative 3-D imaging Dyna-CT are described based on the current literature. RESULTS: The implementation of angio-hybrid operation theaters has resulted in new open interventional treatment options which can also be employed for high risk elderly patients with aortic and peripheral arterial pathologies. With hybrid operations the radiation exposure and contrast medium exposure can be reduced for patients and an improvement in the results can also be achieved. The implementation of 3-D imaging in the angio-hybrid operation theater could also lead to further improvements, especially for complex aortic procedures. DISCUSSION: Using angio-hybrid operational procedures complex interventions can be carried out with more safety for patients and personnel. The implementation of 3-D imaging Dyna-CT offers additional interesting options for complex aortic procedures.

[The interdisciplinary hybrid operation theatre. Current experience and future]. / Der interdisziplinäre Hybridoperationssaal. Erfahrungen und Zukunft.

Since June 2013 a hybrid operation theatre is used interdisciplinary in the department for surgery of Ulm University. In this operation theatre a floor-based flat panel c-arm, which is mounted on a robotic arm that can be controlled by the surgeon in a sterile environment, is linked to the operating table. Furthermore for the first time it was possible to integrate a navigation system in this setting. The interdisciplinary utilization (trauma, neurosurgery, cardiac and vascular surgery) makes this hybrid operation theatre very time and cost effective. In the orthopedic trauma department this system is mainly used for traumatic and oncologic pelvic and spinal injuries. In these anatomical regions the excellent image quality and large field of view of the robotic flat panel detector based 3D imaging combined with an intraoperative navigation system is a huge advantage. The system can also be used for complex fractures of the extremities. In the future there will be an integration of further imaging modalities and referenced holding devices in this setting.

[Hybrid operation theatre from the perspective of neurosurgery]. / Hybridoperationssaal aus Sicht der Neurochirurgie.

BACKGROUND: The integration of hybrid operation theatre into neurosurgical and neuroradiological routines is revolutionizing in particular the management of neurovascular emergencies, such as subarachnoid aneurysmal hemorrhage (SAH) or ruptured arteriovenous malformations. RESULTS: The direct interaction between neurosurgeons and neuroradiologists in a joint environment changes and accelerates all diagnostic and therapeutic steps because all relevant procedures, including treatment control can be performed in a single room. Interventions of the skull base or the spine are also a domain of such hybrid theatre. CONCLUSION: As this new concept requires organisational changes throughout the entire patient management, a change of mindset is also needed at the institutional level in order to attain maximum benefits from such a setting.

[Robotic surgery]. / Robotsebészet.

Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures.

Neurosurgery in India: an overview.

This overview of neurosurgery in India during the last six decades gives a holistic perspective of the phenomenal advances made. Neurosurgical education, the change in clinical spectrum of diseases and their presentation, evolution of various subspecialties and societies, the state of research, the issues peculiar to India, including the urban-rural health divide, the increasing role of information and communication technology in neurosurgery, and the gradual but definite global recognition of Indian neurosurgery will be addressed.