I think I have a good idea: what do I do with it?

The orthopaedic device industry is an ever changing market, often guided by creative surgeons who have the common goal of creating a solution to a problem. While being a surgeon-inventor can be both a challenging and rewarding process, there are several steps that the individual must follow to create intellectual property. This article serves as a guide to the novice surgeon-inventor; intended to be used as an early stage reference for those interested in taking their "solution to a problem" to the device industry.     

How do I do it? Passing a Pedicled Flap Through a Subcutaneous Tunnel

Latissimus dorsi myocutaneous flaps are used to cover body structures or replace tissue that has been lost due to trauma, infection, or surgical excision for tumor. Transfer of these flaps from donor to recipient site is a vital step of surgery as forceful passage of flap may cause damage to blood supply of flap or devitalize the tissue by excessive shearing force. Use of polyvinyl chloride bag for transfer of latissimus dorsi flap through subcutaneous tunnel has been found to be very effective in dealing with this problem.     

What is needed to become a good surgeon?

This lecture has been delivered as a part of the RBSS-BAST symposium ‘What does it need to become a good surgeon’. The lecture relates to the evolution that has taken place over the last decades in relation to the training in surgery. It also gives some hints to younger colleagues how to make a successful career in surgery.     

How do I select cerebral protection devices today?

The establishment of cerebral protection has matured conceptually and clinically in recent years. We have accepted that some type of cerebral protection is desirable. We have some choices in whether to use filters, proximal occlusion, or proximal occlusion with reversed flow. There are anatomical and clinical factors that drive the choice of cerebral protection devices. Certain practical applications of cerebral protection technologies can be made based upon clinical experience. Making carotid artery stenting (CAS) safer is the key to a broader application of CAS as a treatment method and optimal selection of atherosclerosis new cerebral protection devices helps to achieve that goal.     

How I do it – selective amygdalohippocampectomy via subtemporal approach

Background

Surgery is superior over medicamentous treatment of pharmacoresistant mesial temporal lobe epilepsy caused by hippocampal sclerosis. The armamentarium of surgical procedures comprises standard temporal lobectomy and more selective procedures. Selective amygdalohippocampectomy can be performed via transcortical, transsylvian or subtemporal approach.

Method

Describe the selective amygdalohippocampectomy through the subtemporal approach

Conclusion

After the detailed preoperative epilepsy evaluation, surgery can be offered to pharmacoresistant epilepsy patient with hippocampal sclerosis. Selective amygdalohippocampectomy can be safely performed through the subtemporal approach. The good knowledge of the mesial temporal lobe anatomy is necessary when performing this procedure.

Key points

? Perform the subtemporal craniotomy with additional bone removal up to temporal petrous part to minimize retraction of the brain. ? Release the CSF from the subarachnoid sulcal space in order to relax the temporal lobe. Dissect the arachnoid around basal temporal veins and protect them with hemostatic material in order to avoid vein rupture. ? After gyrus fusiformis corticotomy, always follow the white matter in order to enter the temporal horn. ? Place the self-retraining retractor gently to secure an unobstructed view of the intraventricular mesial temporal lobe structures. ? Visualize the choroid plexus and the inferior choroidal point. They represent the two most important landmarks. ? While performing the anterior disconnection the goal is to reach the arachnoid of the interpeduncular and crural cistern medially and the tentorial edge laterally. ? Follow the tentorial edge and the arachnoid of the temporal base to securely perform the lateral disconnection. ? Perform the posterior disconnection at the level of the mesencephalon superior colliculi. ? During the medial disconnection the dissection of the arachnoid of the hippocampal sulcus must be done as close to the hippocampus as possible in order to avoid damage to the brain stem perforators or the loop of the anterior choroidal artery. ? Knowledge of mesial temporal lobe anatomy is crucial.