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1.
Indian J Ophthalmol ; 70(10): 3673-3676, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36190070

RESUMO

Phacoemulsification in soft cataracts can be challenging due to the lack of rigid cleavage planes and the inability to crack. We describe a new phacoemulsification technique for dealing with soft cataracts using high vacuum and zero energy. Following capsulorhexis and hydrodissection, we introduced the phacoemulsification probe, keeping the torsional and longitudinal power at zero. A central groove was created in sculpting mode. We held the nucleus with adequate vacuum in chop mode and divided the nucleus. Then, we rotated and chopped the nucleus similarly into small pieces without using any power. For emulsification, we increased the vacuum to 600 mmHg and then shredded and stuffed the pieces into the phaco probe by the chopper. A newer generation phaco machine with active fluidic system and monitored pressurized infusion helps the surgeon control the intraocular pressure (IOP) and hold the nucleus with vacuum alone, allowing chopping and emulsifying of the pieces without any energy.


Assuntos
Extração de Catarata , Catarata , Facoemulsificação , Capsulorrexe/métodos , Humanos , Microcirurgia , Facoemulsificação/métodos
2.
Dis Markers ; 2022: 5062591, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36193500

RESUMO

Objective: To investigate the prognosis and influencing factors of early microsurgery for severe hypertensive brainstem hemorrhage. Methods: The clinical data of 19 patients with severe hypertensive brainstem hemorrhage treated in the Department of Neurosurgery of the Second Affiliated Hospital of Shandong First Medical University between January 2018 and December 2021 were retrospectively analyzed. The clinical efficacy and risk factors affecting the prognosis were analyzed by chi-square test and multivariate logistic regression. Results: A total of 19 patients with severe hypertensive brainstem hemorrhage were treated by early microsurgery, including 14 cases by subtemporal approach and 5 cases by retrosigmoid approach. After 3 months of follow-up, 6 patients died and 13 patients survived. The 30-day and 90-day mortality rates were 21.1% and 31.6%, respectively, and the good prognosis rate was 15.4%. Univariate analysis showed that hematoma volume and hematoma clearance rate might be the factors affecting the prognosis of patients with severe hypertensive brainstem hemorrhage; the observed difference was statistically significant (P < 0.05). Multivariate logistic regression analysis further confirmed that hematoma volume was an independent factor affecting the death of patients with brainstem hemorrhage (P < 0.05), while hematoma volume (B: 2.909, OR: 18.332, 95% CI: 1.020-329.458, P: 0.048) was a risk factor. Conclusion: Hematoma volume resulted as an independent factor affecting the death of patients with severe hypertensive brainstem hemorrhage. Early microsurgical clearance of brainstem hematoma contributed to reducing the 30-day and 90-day mortality and improving the prognosis of patients.


Assuntos
Hipertensão , Microcirurgia , Tronco Encefálico/cirurgia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Hipertensão/complicações , Hipertensão/cirurgia , Microcirurgia/efeitos adversos , Prognóstico , Estudos Retrospectivos
3.
Acta Cir Bras ; 37(6): e370604, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36074397

RESUMO

PURPOSE: To evaluate the caliber of an arterial micro-anastomosis in the young growing animal using a continuous suture technique. Additionally, late morphological changes and blood flows distal to the anastomosis were evaluated. METHODS: Seventy-four Wistar rats were submitted to laparotomy to access the aorta for blood flow measurement. The aorta was sectioned using microsurgery technique and an end-to-end anastomosis with continuous suture. After a period of six months to one year, the anastomosis was checked. RESULTS: Regarding the size of the aortas, comparing the pre- and postoperative values, there was an increase of 13.33% in adult animals and 25% in young animals, without any difference in the blood flows. CONCLUSIONS: The arteries of young rats show signs of growth at the site of the anastomosis performed with continuous suture.


Assuntos
Artérias , Microcirurgia , Anastomose Cirúrgica/métodos , Animais , Artérias/cirurgia , Microcirurgia/métodos , Ratos , Ratos Wistar , Técnicas de Sutura , Procedimentos Cirúrgicos Vasculares
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2110-2114, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36086279

RESUMO

Checklist based routine evaluation of surgical skills in any medical school demands quality time and effort from the supervising expert and is highly influenced by assessor bias. Alternatively, automated video based surgical skill assessment is a simple and viable method to analyse surgical dexterity offline without the need for acute presence of an expert surgeon throughout the surgery. In this paper, a novel approach and results for the automated segmentation of microsurgical instruments from the real-world neurosurgical video dataset was presented. The proposed tool segmentation model showcased mean average precision of 96.7% in detecting, and localizing five surgical instruments from the real-world neurosurgical videos. Accurate detection and characterization of motion features of the microsurgical tool from the novel annotated neurosurgical video dataset forms the key step towards automated surgical skill evaluation. Clinical Relevance- Tool segmentation, localization, and characterization in neurosurgical video, has several applications including assessing surgeons skills, training novice surgeons, understanding critical operating procedures post surgery, characterizing any critical anatomical response to the tool that leads to the success or failure of the surgery, and building models for conducting autonomous robotic surgery. Semantic segmentation, and characterization of the microsurgical tools forms the basis of the modern neurosurgery.


Assuntos
Procedimentos Cirúrgicos Robóticos , Cirurgiões , Competência Clínica , Humanos , Microcirurgia , Movimento (Física) , Procedimentos Cirúrgicos Robóticos/educação
6.
Ann Plast Surg ; 89(4): 408-411, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36149981

RESUMO

BACKGROUND: Large soft tissue defects associated with major limb amputation pose a challenge to the reconstructive surgeon due to the 3-dimensional contour of the residual limb and the need to withstand the unnatural shear forces imparted by prosthetic sockets. Fasciocutaneous flaps based on the circumflex scapular system have proven useful for residual limb coverage due to the durability of the tissue provided, the absence of functional morbidity, and the ease of reelevation. A modified, bilobed flap design that incorporates large Burrow triangles into each limb serves to leverage the perforasome anatomy of the posterior trunk to provide maximal 3-dimensional coverage and favorable flap geometry while also facilitating donor site closure. METHODS: A retrospective medical record review was performed for all patients who underwent reconstruction of a residual limb after major amputation using the modified, bilobed scapular-parascapular free flap design at Walter Reed National Military Medical Center between 2018 and 2021. A computer-based application was used to calculate flap area and dimensions based on photographs of preoperative and intraoperative markings. RESULTS: Six patients with varying amputation levels (2 transtibial, 1 transfemoral, 1 hip-disarticulation, 1 hemipelvectomy, 1 transradial) underwent soft tissue coverage using the modified flap design. Mean flap area was 318.4 cm 2 with 51.1 cm 2 attributable to the modified design. This represents a 16% increase over a conventional bilobed design. There were no partial or complete flap failures. CONCLUSIONS: The modified scapular-parascapular flap design enables harvest of a larger and more versatile fasciocutaneous flap with geometry that is well suited for coverage of the residual limb.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Humanos , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Escápula , Retalhos Cirúrgicos
7.
Arch Ital Urol Androl ; 94(3): 360-365, 2022 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-36165486

RESUMO

BACKGROUND: Varicocele is known to have impacts in infertility cases and sperm quality. This review aimed to evaluate the effects of microsurgical varicocelectomy on sperm DNA fragmentation index (DFI) and sperm parameters. METHODS: Open full English text articles from January 2017 to October 2021 were searched from online database including PubMed, EMBASE, Scopus, Cochrane Library and Google Scholar. RESULTS: Systematic search resulted in 277 potential papers. After throughout paper analysis, 5 studies were included in this review. From all five analyzed studies, microsurgical varicocelectomy was statistically proven to reduce DNA fragmentation index by 5.46% (mean difference -5.46; 95% CI: -4.79, -6.13; p < 0.00001). Moreover, the procedure also significantly improved other sperm parameters (sperm concentration +8.23%, sperm motility +7.17%, sperm progressive motility +2.77%, sperm morphology +0.64%). CONCLUSION: Microsurgical varicocelectomy significantly improves spermatogenesis as reflected by biomarkers of infertile men including semen parameters and sperm DNA fragmentation (SDF).


Assuntos
Infertilidade Masculina , Varicocele , Biomarcadores , Fragmentação do DNA , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Microcirurgia/métodos , Sêmen , Contagem de Espermatozoides , Motilidade Espermática , Espermatozoides , Varicocele/complicações , Varicocele/cirurgia
8.
Urol Oncol ; 40(10): 457.e1-457.e7, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36088244

RESUMO

PURPOSE: To investigate the local recurrence rates of men treated with Mohs microsurgery (MMS) for penile carcinoma. The secondary outcome was surgical complications from the MMS procedure or the subsequent reconstructive procedures. MATERIALS AND METHODS: All patients from 2010 to 2020 with penile carcinoma at our institution were seen in a multidisciplinary setting. Patients with Ta, Tis, T1, and T2 disease were considered candidates for MMS. Clinical and pathologic data were collected for analysis. Local recurrence rates were stratified by stage and complications reported per the Clavien-Dindo Grade. RESULTS: A total of 43 patients met inclusion criteria. The median age at diagnosis was 64 years. Stage distribution was Ta in 4.7%, Tis in 58.1%, T1a in 14.0%, T1b in 7.0%, and T2 in 16.3%. No patients had a positive surgical margin after MMS. The overall local recurrence rate was 2% (n = 1) at a median of 47 months. Local recurrence rates at 1, 3, and 5 years for Ta, Tis, and T1 patients were 0%. Local recurrence rates for T2 patients were 14% at 1 year. Complications occurred in 12% (n = 5), all of which were Clavien-Dindo ≤ III. CONCLUSIONS: MMS provides effective local control for Ta, Tis, and T1 penile cancer with an overall local recurrence rate of 2% and an acceptable complication rate. A multi-disciplinary team involving urologic oncology, reconstructive urology, and MMS is essential to patient management.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Penianas , Neoplasias Cutâneas , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Microcirurgia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Neoplasias Penianas/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
Acta Otolaryngol ; 142(7-8): 627-633, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36131532

RESUMO

INTRODUCTION: Squamous cell carcinoma (SCC) of the vocal cord in stages I or II can be treated with radiotherapy (RT) or transoral CO2 laser microsurgery (TLM), with good oncological results. OBJECTIVES: To study the survival of patients with SCC of the vocal cord in early stages, treated with RT or TLM, in a tertiary hospital. MATERIAL AND METHODS: Disease-free survival (DFS), specific survival (SS), and overall survival (OS) were studied in patients diagnosed with stage I and II SCC of the vocal cord, for a span of 10 years of follow-up, based on sociodemographic characteristics of the patient and the primary treatment (TLM or RT). RESULTS: Both treatments achieved good survival rates. However, long-term SS was greater in patients treated with TLM compared to those treated with RT (91.7% vs. 50%, respectively, p = .001). In addition, patients treated with TLM presented a higher OS in the short term than those treated with RT (99.0% vs. 89.1%, respectively. p = .004). CONCLUSIONS AND SIGNIFICANCE: Primary treatment with TLM obtained better results than RT in the survival of patients with SCC of the vocal cord in the early stages.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Terapia a Laser , Dióxido de Carbono , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Glote/patologia , Glote/cirurgia , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Microcirurgia/métodos , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
10.
Neurosurg Rev ; 45(5): 3271-3280, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36066661

RESUMO

Despite being a critical component of any cerebrovascular procedure, acquiring skills in microsurgical anastomosis is challenging for trainees. In this context, simulation models, especially laboratory training, enable trainees to master microsurgical techniques before performing real surgeries. The objective of this study was to identify the factors influencing the learning curve of microsurgical training. A prospective observational study was conducted during a 7-month diploma in microsurgical techniques carried out in the anatomy laboratory of the school of surgery. Training focused on end-to-end (ETE) and end-to-side (ETS) anastomoses performed on the abdominal aorta, vena cava, internal carotid and jugular vein, femoral artery and vein, caudal artery, etc. of Wistar strain rats under supervision of 2 expert anatomical trainers. Objective and subjective data were collected after each training session. The 44 microsurgical trainees enrolled in the course performed 1792 anastomoses (1577 ETE, 88%, vs. 215 ETS, 12%). The patency rate of 41% was independent from the trainees' surgical background and previous experience. The dissection and the temporary clamping time both significantly decreased over the months (p < 0.001). Technical mistakes were independently associated with thrombosis of the anastomoses, as assessed by the technical mistakes score (p < 0.01). The training duration (in weeks) at time of each anastomosis was the only significant predictor of permeability (p < 0.001). Training duration and technical mistakes constituted the two major factors driving the learning curve. Future studies should try and investigate other factors (such as access to wet laboratory, dedicated fellowships, mentoring during early years as junior consultant/attending) influencing the retention of surgical skills for our difficult and challenging discipline.


Assuntos
Curva de Aprendizado , Microcirurgia , Anastomose Cirúrgica , Animais , Competência Clínica , Humanos , Microcirurgia/métodos , Estudos Prospectivos , Ratos , Ratos Wistar
11.
Comput Math Methods Med ; 2022: 9701702, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35983522

RESUMO

Objective: To explore the convolutional neural network (CNN) method in measuring hematoma volume-assisted microsurgery for spontaneous cerebral hemorrhage. Methods: A total of 120 patients with spontaneous cerebral hemorrhage were selected and randomly divided into control and CNN groups with 60 patients in each group. Patients in the control group received traditional Tada formula to calculate hematoma volume and microsurgery. Convolutional neural network algorithm segmentation was used to measure hematoma volume, and microsurgery was performed in the CNN group. This article assessed neurological function, ability to live daily, complication rate, and prognosis. Results: The incidence of postoperative complications in the CNN group (13.33%) was lower than the control group (43.33%). The neurological function and daily living ability in the CNN groups were recovered better. The incidence of poor prognosis in the CNN group (16.67%) was lower than the control group (30.00%). Conclusion: Convolutional neural network measurement of hematoma volume to assist microsurgical treatment of spontaneous intracerebral hemorrhage patients is conducive to early recovery, reducing the damage to the patients' cerebral nerves.


Assuntos
Microcirurgia , Redes Neurais de Computação , Algoritmos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos
13.
Cir Cir ; 90(S1): 84-91, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944112

RESUMO

OBJECTIVES: We aimed to compare outcomes of patients with middle cerebral artery (MCA) aneurysms treated by either microsurgical clipping or endovascular therapy and provide a treatment algorithm based on available evidence. MATERIALS AND METHODS: We performed a retrospective analysis of 77 patients with 95 MCA aneurysms. Demographic, clinical, and aneurysm morphological variables were collected. Patients were divided into two groups depending on the received treatment. Clinical and radiological outcomes were collected at the end of a 1-year follow-up period and compared between both treatment groups. RESULTS: Mean age was 51.4 years. Fifty patients (65%) underwent microsurgical clipping and 27 (35%) were treated by endovascular therapy. Fifty-four patients (70%) presented with subarachnoid hemorrhage, while 23 (30%) were treated for unruptured aneurysms. Patients with subarachnoid hemorrhage were more frequently treated by microsurgical clipping than patients with unruptured aneurysms. Clinical outcomes, including functional status, were similar between treatment groups after 1-year follow-up even when adjusting for clinical presentation. Residual aneurysms were found less frequently in the microsurgical group (OR = 0.09; p < 0.001). CONCLUSIONS: In patients with MCA aneurysms, clinical outcomes at 1 year are similar between microsurgical clipping and endovascular therapy. However, microsurgery is associated with a lower risk of residual aneurysms.


OBJETIVO: Evaluar y comparar desenlaces de pacientes con aneurismas de arteria cerebral media (ACM) tratados mediante clipaje microquirúrgico o terapia endovascular, y proponer un algoritmo de tratamiento basado en evidencia. MATERIAL Y MÉTODOS: Estudio retrospectivo de 77 pacientes con 95 aneurismas de ACM. Se recabaron variables demográficas, clínicas y morfológicas de los aneurismas tratados. Se dividieron a los pacientes en dos grupos dependiendo del tratamiento recibido y se compararon los desenlaces clínicos y radiológicos al final del seguimiento a un año entre ambos grupos. RESULTADOS: La edad promedio fue 51.4 años. 50 pacientes (65%) fueron sometidos a clipaje microquirúrgico y 27 (35%) a terapia endovascular. 54 pacientes (70%) presentaron hemorragia subaracnoidea, quienes fueron tratados mediante microcirugía en mayor proporción que aquellos con aneurismas no rotos. Los desenlaces clínicos, incluyendo el estado funcional, fueron similares entre ambos grupos al año de seguimiento, aún tras ajustar el análisis por presentación clínica. El grupo de microcirugía presentó una menor proporción de aneurismas residuales (OR = 0.09; p < 0.001). CONCLUSIONES: En pacientes con aneurismas de ACM, los desenlaces clínicos a un año son similares entre clipaje microquirúrgico y terapia endovascular. Sin embargo, la microcirugía se asocia a un menor riesgo de aneurismas residuales.


Assuntos
Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Algoritmos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Microcirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
14.
No Shinkei Geka ; 50(4): 779-787, 2022 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-35946367

RESUMO

Microvascular anastomosis is an essential technique for cerebrovascular surgeons. Practicing microvascular anastomosis in off-the-job training is critical to perform high-quality revascularization surgery. Gauze, silicone tubes, and artificial blood vessels are useful for daily training practice. Anastomosis training using rats, if available, is more effective. This paper presents practical training procedures for novice neurosurgeons, in particular related to microvascular anastomosis, to improve their microsurgical techniques.


Assuntos
Microcirurgia , Neurocirurgiões , Anastomose Cirúrgica/métodos , Animais , Humanos , Microcirurgia/métodos , Neurocirurgiões/educação , Ratos , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/métodos
15.
No Shinkei Geka ; 50(4): 889-901, 2022 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-35946373

RESUMO

The operating microscope has been an essential tool in neurosurgery since the late 1960s and continues to be a critically important tool for neurosurgical procedures. However, it may be accompanied by flaws since the neurosurgeon's position during surgery is limited. A newly developed surgical microscope, ORBEYETM(OLYMPUS, Tokyo, Japan), was launched to overcome the shortcomings of the operative microscope and offers 4 K, high-quality, and three-dimensional(3D)imaging. ORBEYETM offers similar visual fidelity but superior ergonomics and educational benefits compared with those of the operating microscope. Exoscopic surgeries maintain the same safety profiles as those using operative microscopes and have the potential to allow neurosurgeons to generalize neurosurgical procedures, which are considered difficult due to the neurosurgeon's awkward positions. This study summarizes the utility of the 4K 3D exoscope, ORBEYETM, and presents our experiences with its use in neurosurgical procedures.


Assuntos
Imageamento Tridimensional , Microcirurgia , Ergonomia , Humanos , Imageamento Tridimensional/métodos , Japão , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos
16.
PLoS One ; 17(8): e0271531, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36006958

RESUMO

BACKGROUND: Tissue adhesives are an alternative to conventional surgical sutures to reduce the time and cost of wound closure and to improve patient comfort. The use of tissue adhesives does not require any subsequent intervention and significantly lowers the volume and rate of blood loss, and reduces the need for transfusions during and after surgery. However, based on their formulation, tissue adhesives' safety profile and functional properties may differ. Therefore, this study aimed to evaluate the basic safety and performance of NE'X Glue® Surgical Sealant, BioGlue® Surgical Sealant, and PREVELEAKTM Surgical Sealant in vitro. METHODS: The basic safety of commercially available tissue adhesives was evaluated using MEM elution assay according to ISO 10993-5 and endotoxin level according to 85. USP. The in vitro performance was evaluated using lap-shear by tension loading test, burst strength test, degradation, and swelling assays. RESULTS: NE'X Glue®, BioGlue®, and PREVELEAKTM did not cause cytotoxicity in MEM elution assay. All surgical adhesives are below the general limit of endotoxin contamination of 20 EU/device. NE'X Glue® and BioGlue® showed the highest and comparable strength properties in lap shear and burst strength tests compared to PREVELEAKTM. NE'X Glue® and PREVELEAKTM are characterized by lower degradation potential than BioGlue®. PREVELEAKTM is characterized by the highest swelling when compared to NE'X Glue® and BioGlue®. CONCLUSIONS: NE'X Glue® is most versatile in terms of functional properties while maintaining the same safety profile as BioGlue® and PREVELEAKTM.


Assuntos
Adesivos Teciduais , Endotoxinas , Humanos , Microcirurgia , Suturas
17.
Otol Neurotol ; 43(8): 950-955, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35941666

RESUMO

OBJECTIVE: Develop a predictive model for incomplete microsurgical resection of sporadic vestibular schwannoma (VS). STUDY DESIGN: Historical cohort. SETTING: Tertiary referral center. PATIENTS: Patients with sporadic VS. INTERVENTIONS: Microsurgery with preoperative intent of gross total resection. MAIN OUTCOME MEASURES: Patient and tumor characteristics that influence extent of resection. RESULTS: Among 603 patients, 101 (17%) had intracanalicular tumors and 502 (83%) had tumors with cerebellopontine angle (CPA) extension. For patients with CPA tumors, 331 (66%) underwent gross total resection and 171 (34%) underwent near-total or subtotal resection (NTR-STR). Multivariable modeling identified older age at surgery, larger linear tumor size, and absence of a fundal fluid cap as predictive of NTR-STR ( p < 0.001). From this model, one can estimate that a 20-year-old with a tumor that has less than 10 mm of CPA extension and a present fundal fluid cap has a predicted probability of NTR-STR of 0.01 (or 1%), whereas a 70-year-old with a tumor that has 30 mm or greater CPA extension and absence of a fundal fluid cap has a predicted probability of NTR-STR of 0.91 (or 91%). Among the 171 patients who underwent NTR-STR, 24 required secondary treatment at the time of last follow-up. CONCLUSION: The primary predictors of incomplete microsurgical resection of VS include older age at surgery, larger linear tumor size, and absence of a fundal fluid cap. These factors can be used to estimate the likelihood of NTR-STR, aiding in preoperative discussions regarding future surveillance and potential need of secondary treatment, as well as shared clinical decision making.


Assuntos
Neuroma Acústico , Radiocirurgia , Adulto , Idoso , Humanos , Microcirurgia , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Sci Robot ; 7(69): eaba8212, 2022 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-36001686

RESUMO

Microrobots have been developed for applications in the submillimeter domain such as the manipulation of micro-objects and microsurgery. Rapid progress has been achieved in developing miniaturized components for microrobotic systems, resulting in a variety of functional microactuators and soft components for creating untethered microrobots. Nevertheless, the integration of microcomponents, especially the assembly of actuators and mechanical components, is still time-consuming and has inherent restrictions, thus limiting efficient fabrications of microrobots and their potential applications. Here, we propose a method for fabricating microrobots in situ inspired by the construction of microsystems in living organisms. In a microfluidic chip, hydrogel mechanical components and artificial muscle actuators are successively photopatterned from hydrogel prepolymer and biomolecular motors, respectively, and integrated in situ into functional microrobots. The proposed method allows the fast fabrication of microrobots through simple operations and affordable materials while providing versatile functions through the precise spatiotemporal control of in situ integration and reconfiguration of artificial muscles. To validate the method, we fabricated microrobots to elicit different motions and on-chip robots with unique characteristics for microfluidic applications. This study may establish a new paradigm for microrobot integration and lead to the production of unique biohybrid microrobots with various advantages.


Assuntos
Robótica , Hidrogéis , Microcirurgia , Músculos
19.
Hand Surg Rehabil ; 41(5): 569-575, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35988913

RESUMO

The purpose of this experimental study was to develop an alternative technique of arterial microanastomosis using only 2 stay-sutures augmented with fibrin glue, and to compare it to the conventional technique in arteries of varying diameters mimicking hand arteries. Eight anastomoses were performed in 7 male rats, including 1 anastomosis each on the 2 femoral, iliac, and carotid arteries, and 2 on the subrenal aorta. The conventional technique was used on one side and on the first aorta anastomosis, while augmented anastomoses were performed on the other side and on the second aorta. Patency was tested 10 min after unclamping; clamping time, blood loss, anastomosis quality score (out of 15 points) and artery diameter were recorded. In arteries of diameter 0.5-2.2 mm, augmented anastomoses were on average 10.7 ± 3.2 min faster to perform (p < 0.0001), with an average of 1.3 ± 0.9 g less blood loss (p < 0.0001) and an average of 2.6 ± 2.5 points higher quality score (p < 0.0001). There were no significant differences between the two techniques in terms of patency rate, regardless of artery size. However, 3 of the 7 augmented anastomoses were non-permeable in the femoral subgroup (i.e., submillimetric arteries). This straightforward technique appears to be time-saving and reliable, provided that the repaired artery is of sufficient size. Subject to clinical validation, this technique might help surgeons treating extensive hand wounds with multiple severed neurovascular bundles.


Assuntos
Adesivo Tecidual de Fibrina , Microcirurgia , Anastomose Cirúrgica/métodos , Animais , Artérias Carótidas/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Masculino , Microcirurgia/métodos , Ratos , Grau de Desobstrução Vascular
20.
Microsurgery ; 42(7): 668-676, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35916247

RESUMO

OBJECTIVES: Lymphedema is always initially treated by combined decongestive physiotherapy (CDP). Those cases, refractory to CDP, may be managed by surgical therapy. One of the most used microsurgical procedures is represented by the technique of lymphatic-venous anastomosis (LVA). But very few papers report long term results of LVA. The aim of this study is to assess the long-term patency of multiple lymphatic-venous anastomosis (MLVA) for the treatment of secondary lymphedemas. METHODS: From January 2014 to December 2014, 101 patients (mean age: 56.94 ± 8.98 years; female/male: 86/15) affected by secondary cancer-related lymphedema (38 lower and 63 upper limbs) were treated by MLVA. All lymphedemas had previously been treated by conservative therapy without sustained results. Many patients (78%) had 1-3 episodes of acute lymphangitis/year. Lymphoscintigraphy, venous duplex-ultrasonography, and abdominal or axillary ultrasound investigation were performed preoperatively. MLVA patency was assessed by the lymphatic transport index (LyTI) and lymphoscintigraphic pattern. RESULTS: At 1 year after surgery, excess volume reduction was 75%-90% in the early stage II secondary lymphedemas, and 60%-75% in the late stage II. The decrease in volume maintained stability in the 5-years follow-up period. Two more advanced lower and one upper limb lymphedemas had 45%-60% reduction. LyTI showed a significant decrease between the preoperative mean value (31.7 ± 9.43) and after 18 months from surgery (11.2 ± 1.91) (p < .001). MLVA patency was shown in 98 (97%) patients. No patients had evidence of postoperative lymphangitis. CONCLUSIONS: This study demonstrated the long-term patency of MLVA in the treatment of cancer-related lymphedemas.


Assuntos
Linfangite , Vasos Linfáticos , Linfedema , Neoplasias , Idoso , Anastomose Cirúrgica/métodos , Cistina Difosfato , Feminino , Humanos , Linfangite/cirurgia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/etiologia , Linfedema/cirurgia , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/cirurgia , Resultado do Tratamento
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