A newly designed key-hole button

Patients who have undergone frontotemporal craniotomy occasionally complain of scalp deformity in the anterior temporal area. This occurs as a result of inappropriate reconstruction of the temporal muscle and repair of the bone defect at the key hole and surrounding skull. Although several methods have been developed to prevent skin indentation on burr holes located over the convexity, satisfactory cosmetic repair of the key hole remains difficult because of its complicated bone curvature. To prevent such postoperative deformity, the authors designed a button made of hydroxyapatite ceramics to fit the key hole easily. This new, biocompatible "key-hole button" is shaped to alleviate the deformity of the temple by filling the bone defect in a more natural way. The specifications of this device and its clinical application are described.     

A newly designed ergonomic body support for surgeons

Background One of the main ergonomic problems during surgical procedures is the surgeon’s awkward body posture, often accompanied by repetitive movements of the upper extremities, increased muscle activity, and prolonged static head and back postures. In addition, surgeons perform surgery so concentrated that they tend to neglect their posture. These observations suggest the advantage of supporting the surgeon’s body during surgical procedures. This study aimed to design a body support and to test its potential. Methods The optimum working condition for a surgeon is a compromise between the spine and arm positions and the level of effort and fatigue experienced performing a procedure. The design vision of the Medisign group has led to the development of an ergonomic body support for surgeons that is suitable for use during both open and minimally invasive procedures. The feasibility of the newly designed ergonomic body support was assessed during seven surgical procedures. Electromyography (EMG) was performed for back and leg muscles using the body support in an experimental setting. Results Six of seven participating surgeons indicated that the body support was comfortable, safe, and simple to use. The EMG results show that supporting the body is effective in reducing muscle activity. The average reduction using chest support was 44% for the erector spinae muscle, 20% for the semitendinosus muscle, and 74% for the gastrocnemius muscle. The average muscle reduction using semistanding support was 5% for the erector spinae, 12% for the semitendinosus muscle, and for 50% for the gastrocnemius muscle. Conclusion The results of this study imply that supporting the body is an effective way to reduce muscle activity, which over the long term may reduce physical problems and discomfort. Additionally, the product supports the surgeon in his natural posture during both open and minimally invasive procedures and can easily be adapted to the current layout of the operating theater.     

A newly designed SIPC device for management of lymphoedema

Purpose  

Using (Sequential) intermittent pneumatic compression (SIPC) is one of the most appropriate nonsurgical treatments for lymphoedema. In this study, we introduce a new mode for SIPC and evaluate its clinical results with higher pressures.     

A newly designed single dissector useful for laparoscopic cholecystectomy

Summary We developed a modified dissector capable of carrying out a one-hand operation involving three fundamental functions: grasping, sharp or blunt dissection, and dividing the tissues. With this single dissector, laparoscopic cholecystectomy can be rapidly and safely performed without changing the forceps or instruments through the trocar.     

A newly designed attachment device of multipurpose frame for neuronavigator

Summary A newly designed attachment device of the multipurpose head frame (Sugita) for Neuronavigator (Watanabe) is presented with an illustrative case of glioblastoma in an eloquent area. This has extended the usefulness of the neuronavigator for those who prefer and use the multipurpose head frame, while the requirements for keeping a stereotactic combination and the original concept of the multipurpose head frame, as well as that of the neuronavigator have been kept undisturbed.     

A newly designed clamp facilitates hepatic resection

We designed a new clamp (Inokuchi liver clamp), mainly used for partial or wedge resection of the liver. This clamp is gently curved and has 9 non-traumatic teeth with double step locking devices at the tips. This clamp proved to be most useful for limited hepatic resection, a common procedure for primary liver cancer associated with cirrhosis, however, it can also be used for major resections. From August 1981 to February 1984, this clamp was used by our surgical team in 45 resections of the liver for primary and secondary malignant tumors and benign hemangiomas.     

A newly designed clamp facilitates hepatic resection

We designed a new clamp (Inokuchi liver clamp), mainly used for partial or wedge resection of the liver. This clamp is gently curved and has 9 non-traumatic teeth with double step locking devices at the tips. This clamp proved to be most useful for limited hepatic resection, a common procedure for primary liver cancer associated with cirrhosis, however, it can also be used for major resections. From August 1981 to February 1984, this clamp was used by our surgical team in 45 resections of the liver for primary and secondary malignant tumors and benign hemangiomas.     

The use of an antibiotic-impregnated,osteoconductive, bioabsorbable bone substitute in the treatment of infected long bone defects: early results of a prospective trial

OBJECTIVE: We sought to evaluate the use of a bioabsorbable, tobramycin-impregnated bone graft substitute (calcium sulfate alpha-hemihydrate pellets) in the treatment of patients with infected bony defects and nonunions. STUDY DESIGN/METHODS: Twenty-five patients (15 male and 10 female, mean age 43 years (range 27-69 years) requiring surgical debridement of culture-positive long bone infection (16 with associated nonunion) were entered into an ongoing consecutive, prospective clinical trial. Involved bones included the tibia ( 15), femur ( 6), ulna ( 3), and humerus ( 1). All defects were posttraumatic in origin, and each patient had had previous surgery at the involved site (mean 4.3 surgeries; range 1-8 surgeries). The duration of infection ranged from 4 months to 20 years (mean 43 months). According to the Cierny-Mader classification system, there was 1 stage I (medullary osteomyelitis), 6 stage III (localized osteomyelitis), and 18 stage IV (diffuse osteomyelitis) lesions. There were 4 normal (A) hosts and 21 locally and/or systemically compromised (B) hosts. Mean bone defect/void was 30.5 cm (range 3-192 cm ). RESULTS: Mean follow-up was 28 months (range 20-38 months). Radiographically, pellets were resorbed at a mean of 2.7 months postoperatively. Infection was eradicated in 23 of 25 patients (92%). Isolated bony defects healed in all nine patients without further treatment. Fourteen of 16 patients with nonunion achieved union, although nine required autogenous bone grafting. Union was achieved in five of seven nonunion patients treated with bone graft substitute in isolation. Complications included refracture (three), recurrence of infection (two), persistent nonunion (two), and superficial wound necrosis (one). Eight patients developed sterile draining sinuses that healed upon radiographic resorption of the pellets. CONCLUSIONS: In patients with posttraumatic osteomyelitis, the bone graft substitute was effective in eradicating bone infection in 23 of 25 patients. Isolated bony defects healed reliably (nine of nine) following addition of bone graft substitute alone. The role of the bone graft substitute in isolation in the treatment of nonunion is unclear at present.     

A newly designed disposable introducer sheath for a ventricular fiberscope.

We have developed a disposable plastic introducer sheath for use with a flexible endoscope during intraventricular procedures. The sheath is composed of a thin polypropylene tube passing through the center of a plastic stopper. The tube serves as a sheath through which the fiberscope is introduced into the ventricle. The stopper seats in the burr hole and prevents downward and lateral movement of the tube. The sheath can be placed safely in the ventricle with a drainage catheter used as an introducing guide. We used this sheath system in 10 patients and found it very useful. Manipulation of the fiberscope was not hindered, copious irrigation was allowed, and the sheath remained stable on the skull. This new introducer sheath may contribute to the increased use of a flexible endoscope in neuroendoscopic procedures.     

A newly designed curved venous cannula with cuff for cardiopulmonary bypass

A new venous cannula for CPB was designed. This cannula is curved at right angles to connect to line directly and has cuff to prevent sliding out. We have no trouble with venous return and operative field is not disturbed with CPB lines by using this cannula.     

Ligation of the thoracic duct without thoractomy as an effective treatment for postoperative chylothorax: A newly designed surgical procedure

We describe herein a newly designed surgical procedure for ligating the thoracic duct to treat postoperative chylothorax, without performing a thoractomy. This technique was successfully performed on a 50-year-old man who developed chylothorax following resection of carcinoma of the esophagus whose case is briefly presented. The advantages of this procedure include the following: the integrity of the thorax is maintained, there is less traumatization, the need for a drainage tube is eliminated, shorter hospitalization is required, and the thoracic duct is much more easily exposed than by conventional transthoracic approaches. No similar report was found in our research of the literature.     

A newly designed adapter for testing an ex vivo mitral valve apparatus

Few instruments are currently available to test mitral valve function in an ex vivo state due to the technical difficulties involved. To investigate the native ex vivo mitral valve or prosthetic mitral valve with chordae, we developed a mitral valve adapter with an annulus suturing portion and 2 papillary muscle suturing sites that can be changed in angle, direction, and length of chordae. We used this adapter to test an ex vivo mitral apparatus in beagle dogs and evaluated the morphology and function of the mitral apparatus by endoscopy. Our newly designed mitral valve adapter proved extremely useful for examining the ex vivo mitral valve anatomy and function and for testing stentless mitral prostheses with annular-papillary muscle continuity.     

Use of the newly designed long-handled forceps for respiratory surgery]

We report on use of the newly designed long-handled forceps for respiratory surgery. The forceps have a curved-end in the same plane as its handles. This contributes to the easier clamping of vessels running horizontally in the deep fields. It is very useful not only in thoracic surgery, such as respiratory and esophageal surgery, but also in pelvic surgery.     

A newly designed vertebral replacement implant to reconstruct the thoracolumbar spine anteriorly

Calcium phosphate compounds are becoming of increasingly great importance in the field of biomaterials and, in particular, as bone substitutes. In this way donor-side morbidity can be avoided. A type A lesion of the vertebral body can be the reason of a neurological deficit, requiring a corpectomy by means of an anterior approach, tricortical bone grafting and internal stabilization to get a fusion over time. It is our aim to introduce in this study a newly designed vertebral replacement device, tested in an animal model, using domestic pigs. Two biomaterials, Cementek and Biobon were primarily macroscopically and microscopically evaluated, using a critically sized bone defect of a vertebral body and compared with autologous bone grafts. The final tests consisted of two groups of four animals. A corpectomy at the level of L4 was created and stabilized by means of the newly designed vertebral replacement implant. Autologous bone grafts were applied in one group of animals and Cementek in the other to fill the remaining space. Fusion was studied using anteroposterior and lateral radiographs, followed by a computer tomography. The biocompatibility of the biomaterials and autologous bone grafts were in order of: Cementek > autologous bone grafts > Biobon. In the final tests after a six months period, a fusion was diagnosed in four cases, two delayed unions, and two obvious non-unions. An analysis of the failures in this animal study can possibly clarify the shortcomings of this concept. Perhaps, subtle changes of the design combined with other synthetic bone substitutes can possibly improve the fusion rate in the near future.