Characteristics of the healing of wounds of the stomach, intestines and liver after exposure to the plasma scalpel

Results of experimental application of plasma surgical device UMPR-20 in operations on the stomach, intestine and liver in acute and chronic experiments are described. Coagulating properties of the plasma jet were detected responsible for reliable hemostasis in dissection of the parenchymatous organs. As compared with other surgical devices (electroknife, ultrasonic scalpel, laser "Scalpel-1" device) the zone of injury of the underlying tissues is much less and makes up 0.2-0.3 mm. The plasma surgical device UMPR-20 has good prospects in using during operations on parenchymatous organs and for treatment of their injuries.     

Use of a carbon dioxide laser in surgery for benign tumors in polyclinics

Under conditions of municipal polyclinic 111 operations for benign tumors of skin and subcutaneous fat were performed with the application of laser surgical device "Scalpel-1". This device has been shown to be convenient for out-patient clinics due to its technical characteristics and simple handling. The optimum ways of using the carbon dioxide laser for ablation of lipomas, fibromas, hemangiomas and other benign tumors are proposed.     

Computer-guided laser for neurosurgery

On the basis of over 40 neurosurgical laser operations, including CO2, Nd-YAG and simultaneous CO2/Nd-YAG laser procedures, a computer-guided system for spatial control of the laser beam has been developed. The pilot laser has several modes: it can direct the neurosurgeon along the central axis of the surgical microscope to stereotactically determined point-like targets or outline selected layers of underlying volume targets onto superficial surfaces such as scalp and cortex and onto the tissue at the appropriate depth. The active treatment laser can be guided by preoperative CT/MRI or intraoperative ultrasound image data for layer-by-layer resection of tumor. The laser system can be connected to the surgical field by rigid stereotactic means or by neuronavigator. In the present system, a special brain surgery adapter coordinates the imaging system and laser to the surgical field. Thus, the laser system can be used for image-guided surgical orientation, for demarcation of lesions and for actual layer-by-layer removal of tumor.     

从医学激光的物理特性谈泌尿外科手术方法的设计与建立

激光经历半个世纪的发展,已广泛运用于医疗、通讯、科研、工程等领域。在医学领域亦发展迅速,激光现今已成为泌尿外科不可缺少的一种手段,在最常见的三类泌尿外科疾病BPH、结石、肿瘤的外科治疗中均有广泛运用。而通过激光材料及内镜技术的发展,在手术效率、止血、术后并发症方面则迅速改善。对泌尿外科医生来说,了解激光运作基本原理,不同激光的产生、特性及对组织作用的异同对手术方法的建立及手术技巧的改善至关重要。本文就此为广大泌尿外科同仁提供参考。     

The use of Nd:YAG laser in pituitary surgery and evaluation of visual function by visual evoked potential (VEP)

Surgery of pituitary tumors has been improved by microneurosurgical methods. However, despite improvements in surgical results, pituitary tumors still continue to represent a problem and, therefor, prompt a search for new surgical techniques. Since Nd:YAG laser energy penetrates the target tissue more deeply than other instruments, its use in the para- and suprasellar region should be considered.It is well known that Visual Evoked Potential (VEP) is a sensitive and objective method for the valuation of compressive or destructive lesions in or around the optic nerve. Visual function correlates with the latency and amplitude of P100 wave in VEP.We used the Nd:YAG laser in 50 trnassphenoidal operations of pituitary adenomas.Postoperative effects of the laser on visual function was evaluated by conventional neuroophthalmological tests as well as VEP and was compared with preoperative values. Following surgery using Nd:YAG laser, both ues improved due to decompression of optic nerves by tumor removal.In this study, we also examined anterior lobe functions and found that Nd:YAG laser does not affect these functions.Our study shows that Nd:YAG laser has no harmfull effects and seems to be very helpful especially for surgery for invading hormone-activ adenomas.     

Laser microsurgery in oncology: indications, techniques, and results of 5-year experience

Multidisciplinary collaboration has enabled us to use the CO2 laser in many different surgical fields. The 5-year experience at the National Tumor Institute of Milan is reviewed for the evaluation of short- and medium-term results of 321 laser surgical operations of the lower genital tract, 475 cases of lesions of the larynx and oral cavity, and 246 cases of skin lesions. A unified approach was used as regards safety measures, preoperative evaluation, and rules of application of laser instruments. The reliability of the surgical procedures, the proper selection of the cases, and the low rate of postoperative complications allowed outpatient treatment in 76% of the cases, thus reducing the hospitalization costs. The use of the microscope for laser resections under magnification was recognized to be preferable in routine surgical oncology practice. Short- and medium-term clinical results with laser microsurgery were comparable to those with conventional surgery, especially when precise and conservative removal of periorificial lesions was required.     

Use of carbon dioxide laser in emergency surgery of the extrahepatic bile ducts

The principles of surgical techniques of operations with the use of carbon dioxide laser were developed on basis of the authors' personal experience of 8 years in surgical interventions on 65 patients. The stages of the operative approach, cholecystectomy, choledochotomy, +choledocho-duodeno-anastomosis, papillosphincterotomy, and sterilization of the operative wound and intraabdominal abscesses are illustrated by professionally drawn illustration-diagrams. Laser separation of the gallbladder from the liver takes 220 +/- 35 sec, laser hemostasis and cholestasis of the gallbladder bed--245 +/- 40 sec, laser choledochotomy--17 +/- 8 sec, laser duodenotomy--33 +/- 9 sec. No specific complications were encountered after laser interventions.     

Use of laser technique in the surgical treatment of peptic ulcer

The results of surgical treatment of 275 patients with gastric and duodenal ulcer disease with the use of the laser CO2-scalpel are analysed. The use of laser technique permits to improve the results of surgical interventions, and extends the possibilities for the performance of the organ-preserving operations.     

Identification and management of high-risk patients with Klippel-Feil syndrome

The argon surgical laser has been used in 68 neurosurgical procedures that included the removal of intracranial and intraspinal tumors, spinal cord fenestration for syringomyelia, and the production of dorsal root entry zone lesions. Characteristics that make the argon surgical laser a useful microneurosurgical instrument include the availability of a fiberoptic delivery system, a laser spot size that can be varied continuously between 0.15 and 1.5 mm, a single laser-aiming and treatment beam, the transmission of argon laser light through aqueous media such as irrigating or cerebrospinal fluids, and improved hemostasis compared to conventional techniques. The argon laser is limited primarily by its relatively low power output (less than 16 W), which makes the excision of large tumors difficult. However, even with these limitations, which can be used to advantage in the proper setting, the authors' laboratory and clinical experience suggests that the argon surgical laser may be useful in certain microneurosurgical operations.     

Preliminary experience with an 810 nm wavelength diode laser in ENT surgery

The 810 nm diode laser delivers light with similar physical characteristics to the 1064 nm neodymium-yttrium aluminium garnet (Nd-YAG) laser. The diode laser was used in 25 ENT operations instead of the Nd-YAG laser. The laser has worked well and is a suitable surgical alternative to the Nd-YAG laser, with substantial advantages in terms of reliability and low cost ownership. The system size is 391×387 × 160 mm, and it weighs only 11 kg. The high efficiency of the laser diodes allows the system to be run from a standard wall socket electrical supply of less than 1 amp.     

Surgery of the ambulatory patient

The ambulatory treatment of surgical lesions has many advantages. The requirements in equipment are not great; the personnel must include at least one other person besides the operator. A practical knowledge of surgical technique and asepsis is necessary. Procaine solution has distinct advantages as a local anesthetic and has been used in 87 per cent of 1000 operations. Vinethene is the general anesthetic of choice because of its rapid induction and recovery and relative freedom from postanesthetic difficulties.The scope of surgery in the ambulatory patient includes operations upon superficial tumors and cysts, repair of minor deformities, the care of infections, anal lesions, and fractures of the arm and lower leg. Practical suggestions have been made concerning the treatment of these lesions     

Experience with the use of the CO2 laser in surgical operations of the renal parenchyma

The CO2 laser was used successfully for surgery in 43 nephrologic patients. Surgical operations, making use of the CO2 laser take less time than those using conventional techniques, while the damage to renal parenchyma is not so great and the surgical field is dry owing to the sealing of the vessels.     

Surgical approach with Er:YAG laser on osteonecrosis of the jaws (ONJ) in patients under bisphosphonate therapy (BPT)

Osteonecrosis of the jaw (ONJ) in patients on long-term bisphosphonate Therapy (BPT) has been reported with increasing frequency in literature over the past 4 years. Therapy for this condition is still a dilemma. Temporary suspension of BPT offers no short-term benefits; hyperbaric oxygen has no proven efficacy and therefore is not recommended. Intermittent or continuous antibiotic therapy with surgical debridement can be beneficial to palliate the symptoms. Er:YAG laser can be used to eliminate necrotic bone portions by partial or total resection as an alternative to conventional rotary devices. In our study, 91 patients affected by ONJ-BP lesion, for a total of 115 ONJ sites were observed between January 2004 and May 2008 (Department of Odontostomatology, University of Parma). Fifty-five ONJ sites were considered for this study in four different groups, retrospectively identified on the basis of treatment performed (G1–G4). G1: 13 ONJ-BP sites were treated with medical therapy (amoxicillin 1gr x 3/die per os with metronidazole 250 mg x 2/die per os) for at least 2 weeks; G2: 17 ONJ-BP sites received medical treatment in association with cycles of low-level laser therapy (LLLT) applications performed using an Nd:YAG laser (1,064 nm) once a week for 2 months; G3: 13 ONJ-BP sites were surgically treated (sequestrectomy of necrotic bone, debridement, corticotomy/surgical removal of alveolar and/or cortical bone); G4: 12 ONJ-BP sites were treated with surgical therapy performed using an Er:YAG laser (2,940 nm) in association with LLLT. Clinical success has been defined for each treatment performed as: (a) complete mucosal healing free from signs and symptoms (classified as stage “0”) or (b) transition from a higher to a lower stage (Ruggiero staging) for at least 3 months. All the ONJ-BP sites treated with Er:YAG laser (G4 group) had a clinical improvement (100%) and 87.5% of sites had a complete mucosal healing with a mean follow-up of 13 months. The result obtained in the G4 is extremely significant in comparison with those obtained by medical treatment alone or in a traditional surgical approach. Thanks to the high degree of affinity of this wavelength for water and hydroxyapatite, both soft and bone tissues can be easily treated. This technique can also be used for conservative operations whereby necrotic bone is vaporized until healthy bone is reached. In addition, an additional advantage of the Er:YAG laser is its bactericidal and possible biostimulatory action, accelerating the healing of both soft tissues and bone tissues, in comparison to conventional treatments. In conclusion, from our experience, it is possible to observe that an early conservative surgical approach with Er:YAG laser associated with LLLT, for BP-induced ONJ could be considered as more efficient in comparison with medical therapy or other conventional techniques.     

How robotics is changing and will change the field of colorectal surgery

During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci^® robotic system. The fourth generation da Vinci^® system, introduced in 2014, includes integrated table motion, intelligent laser targeted docking and more sophisticated instrumentation and imaging. These developments have enabled more surgeons to efficiently and safely perform multi-quadrant operations. Firefly^® technology allows assessment of colon perfusion and identification of ureters, and has shown potential in detecting occult recurrence or metastasis using molecular-labelled tumor markers. Wristed instrumentation has increased the technical ease of intracorporeal anastomosis (ICA) for many surgeons, leading to more common use of ICA during right colectomy. Advanced imaging has shown potential to decrease the incidence of presacral nerve injury and improve urogenital outcomes after pelvic surgery, as has been the case in robotic urologic procedures. Finally, the robotic platform lends itself to surgical simulation for surgical trainees, as a pre-operative tool for mock operations and as an ongoing assessment tool for established colorectal surgeons. Given these advantages, surgeons should anticipate continued and increased utilization of this beneficial technology.     

Nd-YAG laser for general surgery

We report here our clinical experiences with Nd-YAG laser on general surgery, and evaluate the results of this procedure. From December 1979 to December 1981, we applied Nd-YAG laser to various operations as a hemostatic and cutting tool. For hemostasis, we used conventional quartz fiber which was covered with sterile tube, and hemostatic efficacy was examined especially in the subcutaneous bleeding and the bleeding from solid organs. For cutting, we used special devices, ie, Medilas YAG surgical probe (noncontact-type probe), and a laser blade (contact-type probe), and performed four liver resections. It is concluded that the hemostatic efficacy of Nd-YAG laser to various bleeders was proved in general surgical procedures, and furthermore this laser can cut tissue if we utilize these devices. When comparing these two devices, we would prefer the contact-type probe.     

Experience in the use of laser instruments in surgery of the anorectal region

The article discusses experience in surgical treatment of 480 patients with the most common diseases of the anorectal region (acute and chronic haemorrhoids, acute and chronic paraproctitis, polyps, chronic fissures of the anal canal) in which special laser tools were used. The carbonic acid laser Skalpel-1 with a wave length of 10.6 microns and power of 30 W was used as the source of laser radiation. Methods of operations with the use of these tools are described in detail. The advantages of laser instruments in the treatment of patients with the above listed diseases are shown on a rich clinical material.     

General surgical operations in the United States. 1979 to 1984

Utilizing data from the National Center for Health Statistics, an in-depth analysis of numbers of general surgical operations from 1979 to 1984 was performed. During the study period, there was an increase in the total number of general surgical operations of 7%. During the same five-year period the number of general surgeons increased by 13%. The 25 most common general surgical operations constitute 71% of all general surgical operations. In 1983, general surgical operations represented 27% of all surgical procedures completed in this country. These statistics illustrate the dynamics of general surgical practice. They show that the number of general surgical operations has minimally increased over the last five years, despite a constantly increasing number of general surgeons. If current trends continue, then future individual operative workloads will decrease with possible adverse effects on the quality of general surgical care.     

Current strategies in the surgical treatment of atrial fibrillation: review of the literature and Onze Lieve Vrouw Clinic's strategy

Atrial fibrillation is the most common rhythm disturbance in clinical practice. It is a major source of stroke and morbidity. Although the Cox maze procedure effectively eliminates atrial fibrillation in most patients, the procedure has not found widespread application. As a consequence, new operations that use alternative sources of energy, such as radiofrequency, microwave, cryothermy, laser, and ultrasound have emerged to surgically create lesion sets to treat atrial fibrillation. This article reviews the fundamentals and current strategies in the surgical treatment of atrial fibrillation.     

Surgical operations in the United States: 1979 to 1984

With data from the National Center for Health Statistics, an in-depth analysis of the number of surgical operations performed in the United States from 1979 to 1984 was carried out. During the study period, there was a 9% increase in the total number of surgical procedures. For the same time period, the number of surgeons grew 20%. By 1984 general surgical operations were greatest in number. However, the 5-year increase in the number of general surgical operations was just 7%. Although obstetric and gynecologic operations declined 1%, the most common inpatient surgical operation performed in the United States is cesarean section. Orthopedic surgical operations grew 24% and arthroscopy has become this country's sixteenth most frequent operation. Cataract extraction is the fourth most common operation and represents 60% of all ophthalmologic surgery. Cardiothoracic operations had the largest increase, 34%. This study demonstrates the dynamics of surgical practice in the United States and conveys a dual message. There is reassuring news concerning "unnecessary" surgery due to supplier-induced demand for operations. Despite recent large increases in the number of surgeons, there have not been parallel increases in the number of surgical operations. The belief that more surgeons necessarily means more surgery is not noted. The disturbing news concerns surgical case loads. The prospect of more surgeons performing fewer operations has become a major problem. The surgical community will have to address this growing inbalance.     

Plastic surgery in the twentieth century.

Plastic surgical operations are among the oldest and have been developed increasingly from ancient times down to the present. However, the age of medical specialization did not begin until the latter part of the nineteenth century, and the specialty of plastic surgery is largely a child of the twentieth century. Most of the operations we do today have been created by plastic surgeons with the past 50 years, but were made possible only by the rapid developments in other surgical specialties and in all of medicine and science. The relationship with other specialties has been an interdependent one, and this is likely to be the pattern of the future. Plastic surgery, bridging the anatomical specialties as it does, must continue to draw bits of information here and there from them and to synthesize these into major contributions of great benefit to all. The specialty will grow in direct proportion to the success of the innovators within it in fulfilling their crucial role.