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Sample records for single-site surgery access

  1. Laparoendoscopic single-site adnexal surgery: Preliminary Indian experience

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    Smitha Balusamy

    2017-01-01

    Full Text Available Introduction: Laparoendoscopic single-site surgery (LESS is an emerging technique in gynaecology. The proposed advantages of the LESS include better cosmesis and reduction in pain. We report our preliminary experience with LESS in the treatment of adnexal pathology. Materials and Methods: After a preoperative workup, LESS was offered to 37 patients between July 2009 and April 2015. All the procedures were carried out through a 2–2.5 cm transumbilical incision using conventional laparoscopic instruments. A single-incision, multiport (SIMP approach (utilising one 7 mm and two 5 mm ports was used in 27 patients and a homemade glove port (HMGP was utilised in ten patients. All the specimens were extracted after placement in a plastic bag or inside the glove port avoiding contact with the wound. Umbilical fascial incisions were meticulously closed with non-absorbable sutures. Results: Two patients with a history of previous abdominal surgery required omental adhesiolysis. Seventeen patients with breast cancer underwent bilateral salpingo-oophorectomy, ten had ovarian cystectomy (6 had cystadenoma, 2 had endometriotic cysts and 2 had dermoid cyst, six had excision of paraovarian cysts (one along with partial salpingectomy and four with ruptured ectopic pregnancy underwent salpingectomy. LESS was completed in all but one patient, who required insertion of an additional 5 mm port. There were no intra- or post-operative complications. Conclusions: Our experience confirms the feasibility and safety of LESS in a variety of benign adnexal pathology. Both the SIMP and HMGP approaches seem comparable. Performing LESS without the use of specialised access ports or instruments makes it cost effective and suitable for wider application.

  2. Single-site robotic surgery in gynecologic cancer: a pilot study

    OpenAIRE

    Yoo, Ha-Na; Kim, Tae-Joong; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

    2015-01-01

    Objective To discuss the feasibility of single-site robotic surgery for benign gynecologic tumors and early stage gynecologic cancers. Methods In this single institution, prospective analysis, we analyzed six patients who had undergone single-site robotic surgery between December 2013 and August 2014. Surgery was performed using the da Vinci Si Surgical System. Patient characteristics and surgical outcomes were analyzed. Results Single-site robotic surgery was performed successfully in all si...

  3. New Developments in Robotics and Single-site Gynecologic Surgery.

    Science.gov (United States)

    Matthews, Catherine A

    2017-06-01

    Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.

  4. Minimal invasive single-site surgery in colorectal procedures: Current state of the art

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    Diana Michele

    2011-01-01

    Full Text Available Background: Minimally invasive single-site (MISS surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. Methods: We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were "Single Port" or "Single-Incision" or "LaparoEndoscopic Single Site" or "SILS™" and "Colon" or "Colorectal" and "Surgery". Results: Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%. Two "fully laparoscopic" MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. Conclusions: MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control.

  5. Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

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    Fader Amanda

    2011-01-01

    Full Text Available Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

  6. Miniature in vivo robot for laparoendoscopic single-site surgery.

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    Dolghi, Oleg; Strabala, Kyle W; Wortman, Tyler D; Goede, Matthew R; Farritor, Shane M; Oleynikov, Dmitry

    2011-10-01

    The aim of this study was to develop a multidexterous robot capable of generating the required forces and speeds to perform surgical tasks intra-abdominally. Current laparoscopic surgical robots are expensive, bulky, and fundamentally constrained by a small entry incision. A new approach to minimally invasive surgery places the robot completely within the patient. Miniature in vivo robots may allow surgeons to overcome current laparoscopic constraints such as dexterity, orientation, and visualization. A collaborative research group from the Department of Surgery at the University of Nebraska Medical Center and the College of Engineering at the University of Nebraska-Lincoln designed and built a surgical robot prototype capable of performing specific surgical tasks within the peritoneal cavity. The basic robotic design consists of two arms each connected to a central body. Each arm has three degrees of freedom and rotational shoulder and elbow joints. This combination allows a surgeon to grasp, manipulate, cauterize, and perform intracorporeal suturing. The robot's workspace is a hollow hemisphere with an inner radius of 75 mm and an outer radius of 205 mm. Its versatility was demonstrated in four procedures performed in a porcine model: cholecystectomy, partial colectomy, abdominal exploration, and intracorporeal suturing. Miniature in vivo robots have the potential to address the limitations of using articulated instrumentation to perform advanced laparoscopic surgical procedures. Once inserted into the peritoneal cavity, the robot provides a stable platform for visualization with sufficient dexterity and speed to perform surgical tasks from multiple orientations and workspaces.

  7. Transumbilical laparoendoscopic single-site surgery versus conventional laparoscopy for the resection of retroperitoneal paragangliomas.

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    Xu, Weifeng; Li, Hanzhong; Ji, Zhigang; Yan, Weigang; Zhang, Yushi; Zhang, Xuebin; Li, Qian

    2015-09-01

    To compare transumbilical laparoendoscopic single-site surgery with conventional laparoscopy for the resection of retroperitoneal paragangliomas. In the present case-control study, we compared 11 transumbilical laparoendoscopic single-site surgery procedures with 22 conventional laparoscopy procedures carried out to treat retroperitoneal paragangliomas between June 2004 and October 2013 at Peking Union Medical Hospital, Beijing, China. Operative time, estimated intraoperative blood loss, blood transfusions, intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, postoperative fatigue time, postoperative systematic inflammation reaction syndrome, 24-h postoperative visual analog scale scores, postoperative hospital stay duration, and postoperative complications were recorded and analyzed. There were no significant differences in patient characteristics. All surgical procedures were successfully completed in both groups. Minor complications occurred in one case in the laparoendoscopic single-site surgery group and in two cases in the conventional laparoscopy group. In the laparoendoscopic single-site surgery group, the operative time was longer than that in the conventional laparoscopy group (P = 0.001). There were no significant differences in terms of intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, estimated blood loss, postoperative fatigue time, postoperative hospital stay or systematic inflammation reaction syndrome between the two groups. The 24-h postoperative visual analog scale score was lower in the laparoendoscopic single-site surgery group (P = 0.002). No recurrence or metastases were observed over the duration of the postoperative follow up. In properly selected patients, transumbilical laparoendoscopic single-site surgery is a feasible, safe and effective

  8. Patients' perceptions of laparoendoscopic single-site surgery: the cosmetic effect.

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    Golkar, Farhaad C; Ross, Sharona B; Sperry, Steffanie; Vice, Michelle; Luberice, Kenneth; Donn, Natalie; Morton, Connor; Hernandez, Jonathan M; Rosemurgy, Alexander S

    2012-11-01

    Laparoendoscopic single-site (LESS) surgery can be performed without apparent scarring, while maintaining the salutary benefits of conventional laparoscopic surgery. The purpose of this study was to compare patients' preoperative and postoperative perceptions of LESS surgery. Before and after undergoing LESS surgery, 120 patients were given questionnaires; their responses were assimilated and analyzed. Of 120 patients, 62% were female (age, 52 ± 16.6 y), and 54% had prior abdominal surgery. Preoperatively, women and older patients reported heightened appearance dissatisfaction. Preoperatively, most patients would not accept more risk, pain, surgery/recovery times, and/or costs than associated with standard laparoscopy. Postoperatively, patients reported increased satisfaction in their overall and abdominal region appearance. Satisfaction was noted by 92%; satisfaction was related significantly to scar appearance and cosmesis. Preoperatively, patients were most concerned with safety; postoperatively, patients' concerns shifted to cosmetic outcome. LESS surgery provides an opportunity for improved patient satisfaction. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. The use of expanding ports in laparo-endoscopic single-site surgery may cause more pain

    DEFF Research Database (Denmark)

    Dressler, Jannie; Jorgensen, Lars N

    2017-01-01

    BACKGROUND: Previous meta-analyses on the clinical outcome after laparo-endoscopic single-site surgery (LESS) versus conventional laparoscopic surgery (CLS) have not revealed any major differences in postoperative pain between the two procedures. This meta-analysis aims to evaluate the difference...... for randomized clinical trials (RCTs) on LESS versus CLS for general abdominal procedures. Weighted mean difference (WMD) and Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS: A total of 29 RCTs with 2999 procedures were included. Pain (VAS 0-10) 6 h after surgery was significantly...... in LESSex procedures compared to CLS, OR = 1.94 (1.03-3.63). CONCLUSION: The present meta-analysis indirectly indicates that the type of access device that is used for an abdominal LESS procedure may contribute to the development of early postoperative pain as the use of a non-expanding model was associated...

  10. Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

    Directory of Open Access Journals (Sweden)

    Yasuhiro Sumino

    2011-01-01

    Full Text Available Laparoendoscopic single-site surgery (LESS is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

  11. Insufficient joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery.

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    Jeong, Chang Wook; Kim, Sung Hoon; Kim, Hyung Tae; Jeong, Seong Jin; Hong, Sung Kyu; Byun, Seok-Soo; Lee, Sang Eun

    2013-10-01

    The current articulating instruments used in laparoendoscopic single-site surgery do not appear to provide the joint forces required. Thus, we measured the joint forces of first-generation articulating laparoscopic instruments. To compare these forces with those necessary in the surgical context, we evaluated the forces sufficient to produce secure surgical ties in an animal model. The articulating instruments tested were Laparo-Angle (Cambridge Endoscopic Devices Inc, Framingham, MA), RealHand (Novare Surgical Systems Inc, Cupertino, CA), and Roticulator (Covidien Inc, Mansfield, MA). For each, we measured the angle between the end-effector and the shaft in proportion to the articulating force using a push-pull gauge. Two fixed-position configurations of the instruments were predetermined: the neutral and the fully articulated positions. The forces required to secure surgical ties for the ureter, renal artery, and renal vein were evaluated using kidneys harvested from a female pig. The bending forces required to bend from the neutral position to 30° were 5.6 ± 1.2 and 4.7 ± 1.0 N with the Laparo-Angle and RealHand, respectively. Furthermore, the slippage forces in the fully articulated state were 1.8 ± 0.3, 1.6 ± 0.2, and 1.5 ± 0.2 N in the above order. In contrast, the mean forces to produce surgical ties of the ureter, renal artery, and renal vein were 14.5 ± 2.3, 11.5 ± 0.8, and 10.3 ± 2.3 N, respectively. The joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery are not sufficient to meet the usual operative needs. Improved articulating instruments with greater articulating forces should be developed.

  12. The effectiveness of laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum.

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    Yang, Juseok; Na, Yong Jin; Song, Yong Jung; Choi, Ook Hwan; Lee, Sun Kyung; Kim, Hwi Gon

    2016-02-01

    The purpose of this study was to compare clinical outcomes of conventional laparoscopic surgery and laparoendoscopic single-site surgery (LESS) in the surgical treatment of tubal ectopic pregnancy. A total of 156 patients were diagnosed with ectopic pregnancies by ultrasonography and serum β-human chorionic gonadotrophin (β-hCG) levels at Pusan National University Yangsan Hospital from January 2009 through December 2013. We excluded 28 patients who only received medical treatment, 15 patients who underwent surgery by laparotomy for severe hypovolemic shock, and 30 patients who presented with less than 1 L of hemoperitoneum. Of the 83 patients with massive hemoperitoneum, 38 patients had LESS performed while the remaining 45 patients underwent conventional laparoscopic surgery. In this study, there were no statistically significant differences in clinical outcomes in either surgical method except for operative time. Operative time of LESS was significantly shorter than conventional surgery for patients with more than 500 mL of hemoperitoneum. LESS is a safe and feasible surgical approach in the treatment of tubal ectopic pregnancy. At the same time, LESS has been shown to be more effective than conventional laparoscopic surgery in handling massive hemoperitoneum of more than 1 L, which is a common complication of ectopic pregnancy. Copyright © 2016. Published by Elsevier B.V.

  13. Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices.

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    Di Stasi, Leandro L; Díaz-Piedra, Carolina; Ruiz-Rabelo, Juan Francisco; Rieiro, Héctor; Sanchez Carrion, Jose M; Catena, Andrés

    2017-11-01

    Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves). Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial.

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    Song, Taejong; Cho, Juhee; Kim, Tae-Joong; Kim, Im-Ryung; Hahm, Tae Soo; Kim, Byoung-Gie; Bae, Duk-Soo

    2013-01-01

    To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery. Randomized controlled trial (Canadian Task Force classification I). University hospital. Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery. Laparoendoscopic single-site surgery or multi-port surgery. Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  15. Port site infiltration of local anesthetic after laparoendoscopic single site surgery for benign adnexal disease.

    Science.gov (United States)

    Kim, Jung Eun; Shim, Seung-Hyuk; Dong, Meari; Lee, Hyojin; Hwang, Han Sung; Kwon, Han Sung; Lee, Sun Joo; Lee, Ji Young; Sohn, In Sook; Kim, Soo-Nyung; Kang, Soon-Beom

    2017-09-01

    To determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain. This prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS). There was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55-222] vs. 100 [50-185] minutes, P =0.137) and estimated blood loss (50 [30-1,500] vs. 125 [30-1,000] mL, P =0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2-6] vs. 3.5 [2-5], P =0.478), 6 to 8 hours (3.5 [2-6] vs. 3 [1-8], P =0.478), and 16 to 24 hours (3 [2-4] vs. 3 [1-7], P =0.664) did not differ between groups. Bupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.

  16. Ex-vivo training model for laparoendoscopic single-site surgery

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    Kommu Sashi

    2011-01-01

    Full Text Available Background: Laparoendoscopic single-site surgery (LESS has recently been applied successfully in the performance of a host of surgical procedures. Preliminary consensus from the experts is that this mode of surgery is technically challenging and requires expertise. The transition from trainee to practicing surgeon, especially in complex procedures with challenging learning curves, takes time and mentor-guided nurturing. However, the trainee needs to use platforms of training to gain the skills that are deemed necessary for undertaking the live human case. Objective: This article aims to demonstrate a step-by-step means of how to acquire the necessary instrumentation and build a training model for practicing steeplechase exercises in LESS for urological surgeons and trainees. The tool built as a result of this could set the platform for performance of basic and advanced skills uptake using conventional, bent and articulated instruments. A preliminary construct validity of the platform was conducted. Materials and Methods: A box model was fitted with an R-Port™ and camera. Articulated and conventional instruments were used to demonstrate basic exercises (e.g. glove pattern cutting, loop stacking and suturing and advanced exercises (e.g. pyeloplasty. The validation included medical students (M, final year laparoscopic fellows (F and experienced consultant laparoscopic surgeons (C with at least 50 LESS cases experience in total, were tested on eight basic skill tasks (S including manipulation of the flexible cystoscope (S1, hand eye coordination (S2, cutting with flexible scissors (S3, grasping with flexible needle holders (S4, two-handed maneuvers (S5, object translocation (S6, cross hand suturing with flexible instruments (S7 and conduction of an ex-vivo pyeloplasty. Results: The successful application of the box model was demonstrated by trainee based exercises. The cost of the kit with circulated materials was less than £150 (Pounds Sterling

  17. Laparoendoscopic Single-Site Surgery (LESS) for Excision of a Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis

    OpenAIRE

    Jang, Ki Don; Choi, Kyung Hwa; Yang, Seung Choul; Jang, Won Sik; Jang, Ji Young; Han, Woong Kyu

    2011-01-01

    We report a case of laparoendoscopic single-site surgery (LESS) for a symptomatic left seminal vesicular cyst and ipsilateral renal agenesis. A 49-year-old man presented with a 1-year history of severe irritation upon voiding and intractable, recurrent hematospermia. A computed tomography scan showed a 68×41×38 mm sized left seminal vesicular cyst with ipsilateral renal agenesis. LESS was performed successfully to treat the seminal vesicle cyst. The total operative time was 125 minutes, and b...

  18. Robotic-assisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis.

    Science.gov (United States)

    Barret, E; Sanchez-Salas, R; Ercolani, M; Forgues, A; Rozet, F; Galiano, M; Cathelineau, X

    2011-06-01

    The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.

  19. Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology.

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    Gor, Ronak A; Long, Christopher J; Shukla, Aseem R; Kirsch, Andrew J; Perez-Brayfield, Marcos; Srinivasan, Arun K

    2016-02-01

    To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures. Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification. Hasson technique was used for peritoneal entry, GelPOINT advanced access platform was inserted, and standard 5mm laparoscopic instruments were used. Fifty-nine patients (median age 5 years, 4 months-17 years) met inclusion criteria: 29 nephrectomies, 9 nephroureterectomies, 3 bilateral nephrectomies, 5 heminephrectomies, 5 renal cyst decortications, 3 bilateral gonadectomies, 2 Malone antegrade continence enema, 2 calyceal diverticulectomy, and 1 ovarian detorsion with cystectomy. Median operative times for each case type were comparable to published experiences with traditional laparoscopy. Overall mean and median length of stay was 36.2 hours and 1 day, respectively. There were two complications: port site hernia requiring surgical repair (Clavien IIIb) and a superficial port site infection that resolved with antibiotics (Clavien II). Cosmetic outcomes were subjectively well received by patients and their parents. Operative time was significantly shorter between the first half of the experience and the second half (102 vs 70 minutes, P  <  .05). LESS approach can be broadly applied across many major extirpative and reconstructive procedures within pediatric urology. Our series advances our field's utilization of this technique and its safety. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Laparoendoscopic Single-Site Surgery (LESS for a Large Ovarian Tumour: First Clinical Case Report

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    Yao Dong Chua

    2011-01-01

    Main Outcome Measure(s. Conversion to standard laparoscopic technique or laparotomy, estimated blood loss, operative time , extent of scarring, occurrence of intra- and perioperative surgical complications, technical adequacy, and clinical outcome. Result(s. No conversion to standard laparoscopic technique or laparotomy, and no intraoperative or postoperative complications were observed. Total operative time was 99 minutes. The patient was discharged home on postoperative day one. Conclusion(s. Laparoendoscopic single-site bilateral salpingo-oophorectomy of a large ovarian tumour is feasible with standard laparoscopic instruments. It is safe and effective, with good results in terms of excellent cosmesis and minimal postoperative pain.

  1. Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery.

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    Autorino, Riccardo; Stein, Robert J; Lima, Estevão; Damiano, Rocco; Khanna, Rakesh; Haber, Georges-Pascal; White, Michael A; Kaouk, Jihad H

    2010-05-01

    Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

  2. Laparoendoscopic single-site surgery (LESS) for excision of a seminal vesicle cyst associated with ipsilateral renal agenesis.

    Science.gov (United States)

    Jang, Ki Don; Choi, Kyung Hwa; Yang, Seung Choul; Jang, Won Sik; Jang, Ji Young; Han, Woong Kyu

    2011-06-01

    We report a case of laparoendoscopic single-site surgery (LESS) for a symptomatic left seminal vesicular cyst and ipsilateral renal agenesis. A 49-year-old man presented with a 1-year history of severe irritation upon voiding and intractable, recurrent hematospermia. A computed tomography scan showed a 68×41×38 mm sized left seminal vesicular cyst with ipsilateral renal agenesis. LESS was performed successfully to treat the seminal vesicle cyst. The total operative time was 125 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day.

  3. Limited-Access Heart Surgery

    Science.gov (United States)

    ... Surgery Menu Topics Topics FAQs Limited-Access Heart Surgery Article Info En español Thousands of heart surgeries ... with cardiovascular disease. What is minimally invasive heart surgery? In minimally invasive heart surgery, surgeons take steps ...

  4. Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses.

    Science.gov (United States)

    Chantada, C; García-Tello, A; Esquinas, C; Moraga, A; Redondo, C; Angulo, J C

    Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (Plaparoscopy (P=.0013). Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Clinical Appliance of Laparo-Endoscopic Single-Site Surgery (LESS) in Urology.

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    Liatsikos, Evangelos; Kyriazis, Iason; Kallidonis, Panagiotis; Do, Minh; Anja, Anja; Rigopoulos, Christos; Al-Aown, Abdulrahman; Stolzenburg, Jens-Uwe

    2010-04-01

    Laparoscopy has gained a place in everyday surgical routine as an alternative surgical approach that decreases morbidity and postoperative hospitalization. Single port laparoscopic surgery has been introduced as a further development of laparoscopy. The feasibility and safety of single port laparoscopy is under extensive evaluation in specialized laparoscopic centers. Nevertheless, wide acceptance of the technique requires adequate documentation of the advantages of the approach over conventional laparoscopy and further refinement of surgical instrumentation to overcome intraoperative ergonomic problems.

  6. [Laparoendoscopic single-site surgery in gynecology: the situation in 2013].

    Science.gov (United States)

    Rabischong, B; Compan, C; Savary, D; Bourdel, N; Canis, M; Mage, G; Botchorishvili, R

    2013-09-01

    Single-incision laparoscopic surgery (SILS) is a recent technic of minimally invasive surgery that arouses a growing interest due to its potential benefits in terms of pain and cosmetic. However, in gynecology as well as in other surgical specialties, preliminary results seem to be controversial. Its feasibility and interest by comparison with conventional laparoscopy (CL) have not been confirmed by randomized multicenter studies. Compare in gynecological surgery, feasibility and surgical outcomes (conversion rate and complications, postoperative pain, duration of surgery, length of hospital stay, appearance and cost) between SILS and CL. For this, a review of the literature from a PUBMED and Medline databases was conducted. The clinical cases and series with fewer than 10 patients were excluded. Eligible data were compared and analyzed. A total of 46 studies including five prospective randomized were studied in gynecology. Conversion rates and complications appear identical to those of the CL. The learning curve is also comparable. The technique is not standardized and some ergonomic problems are described. Operating time and duration of hospitalization seems to be comparable. The postoperative pain assessment found conflicting results. The cosmetic results are in favor of the single incision laparoscopy. Finally, the cost is higher. According to the literature, the single incision laparoscopy seems feasible and safe, with better cosmetic results. But the cost is increased and associated with no benefit in terms of pain, operating time and duration of hospitalization. Beyond cosmetics results, further randomized studies are needed to identify a possible benefit. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  7. Laparoendoscopic Single-site Surgery (LESS) for Prophylactic Salpingo-oophorectomy Improves Cosmetic Satisfaction Compared to Standard Laparoscopy.

    Science.gov (United States)

    Miailhe, Gregoire; Dauchy, Sarah; Bentivegna, Enrica; Gouy, Sebastien; Charles, Cecile; Delaloge, Suzette; Morice, Philippe; Uzan, Catherine

    2015-11-01

    Less invasive prophylactic bilateral salpingo-oophorectomy (PBSO) may diminish the general consequences of surgery for BRCA mutation carriers. The objective of the present study was to compare the psychological impact and satisfaction following minimal-invasive laparoendoscopic single-site surgery (LESS) versus that observed with the standard procedure. This prospective longitudinal study was proposed to all consecutive patients who underwent ambulatory PBSO between January 2012 and January 2014 at our Center. The psychological impact and esthetic satisfaction were prospectively studied. Patients rated their satisfaction using the 4-grade Likert scale. Their emotional state and postoperative pain were explored respectively with validated questionnaires (IES-R, PANAS) and the Verbal Numerical Rating Scale (VNRS). Operative outcomes were also analyzed. Twenty patients underwent LESS PBSO and 10 patients had the standard laparoscopic (SL) PBSO. The mean satisfaction scores were significantly higher in the LESS group one month and six months after surgery. Both groups reported a reduction of intrusive thoughts and negative affects after surgery. Postoperative pain and operative outcomes were similar. A significant improvement of cosmetic satisfaction after LESS compared to SL could help patients accept PBSO. The emotional impact of PBSO is not modified by ambulatory LESS. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  8. Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

    Directory of Open Access Journals (Sweden)

    Deepak Dubey

    2011-01-01

    Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

  9. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery.

    Science.gov (United States)

    Chen, Kuo-Hu; Chen, Li-Ru; Seow, Kok-Min

    2015-01-01

    To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. Prospective cohort study (Canadian Task Force classification: II-2). University teaching hospital. One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All

  10. A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair.

    Science.gov (United States)

    Tai, Huai-Ching; Lin, Chia-Da; Chung, Shiu-Dong; Chueh, Shih-Chieh Jeff; Tsai, Yao-Chou; Yang, Stephen Shei-Dei

    2011-09-01

    Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach. Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The perioperative data, including patient age, sex, body mass index (BMI), hernia characteristics, operative time, complications, length of hospital stay, return to normal activity, pain score, and cosmetic result, were prospectively collected. All LESS TEP procedures were completed successfully without conversion to standard laparoscopic or open surgery. A total of 98 LESS TEP hernia repairs were performed in 54 patients and compared with 152 standard TEP operations. The mean operative time was significantly shorter in the standard TEP series (61.8 ± 26.0 vs. 70.9 ± 23.8 min, p = 0.04). Other perioperative parameters, including the length of hospital stay, time until return to full activity, complication rate, pain score, and cosmetic result, were all comparable between the two techniques. Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced hands, inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique. However, based on our evidence, we currently believe that the LESS TEP technique is not an efficacious surgical alternative to the standard TEP technique for inguinal hernias.

  11. Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist.

    Science.gov (United States)

    Abdel-Karim, Aly M; Elhenawy, Ibrahim M; Eid, Ahmed A; Yahia, Elsayed; Elsalmy, Salah A

    2017-09-01

    To define the learning curve of laparoendoscopic single-site surgery (LESS) of an experienced laparoscopist. Patients who had LESS, since its implementation in December 2009 until December 2014, were retrospectively analysed. Procedures were divided into groups of 10 and scored according to the European Scoring System for Laparoscopic Operations in Urology. Different LESS indications were done by one experienced laparoscopist. Technical feasibility, surgical safety, outcome, as well as the number of patients required to achieve professional competence were assessed. In all, 179 patients were included, with mean (SD) age of 36.3 (17.5) years and 25.4% of the patients had had previous surgeries. Upper urinary tract procedures were done in 65.9% of patients and 54.7% of the procedures were extirpative. Both transperitoneal and retroperitoneal LESS were performed in 92.8% and 7.2% of the patients, respectively. The intraoperative and postoperative complication rates were 2.2% and 5.6% (Clavien-Dindo Grade II 3.9% and IIIa 1.7%), respectively. In all, 75% of intraoperative complications and all conversions were reported during the first 30 LESS procedures; despite the significantly higher difficulty score in the subsequent LESS procedures. One 5-mm extra port, conversion to conventional laparoscopy and open surgery was reported in 14%, 1.7%, and 1.1% of the cases, respectively. At mean (SD) follow-up of 39.7 (11.4) months, all the patients that underwent reconstructive LESS procedures but one were successful. In experienced hands, at least 30 LESS procedures are required to achieve professional competence. Although difficult, both conversion and complication rates of LESS are low in experienced hands.

  12. Laparo-Endoscopic Single-Site Surgery for Radical and Cytoreductive Nephrectomy, Renal Vein Thrombectomy, and Partial Nephrectomy: A Prospective Pilot Evaluation

    Directory of Open Access Journals (Sweden)

    Ithaar H. Derweesh

    2010-01-01

    Full Text Available Introduction. Laparo-endoscopic single-site surgery (LESS may diminish morbidity of laparoscopic surgery. We prospectively evaluated feasibility and outcomes of LESS-Radical Nephrectomy (LESS-RN and Partial Nephrectomy (LESS-PN. Methods. 10 patients underwent LESS-RN (6 and LESS-PN (4 between 2/2009-5/2009. LESS-RN included 2 with renal vein thrombectomy, one of which was also cytoreductive. Transperitoneal LESS access was obtained by periumbilical incision. Patient/tumor characteristics, oncologic, and quality of life (QoL outcomes were analyzed. Results. 3 Men/7 Women (mean age 58.7 years, median follow-up 9.8 months underwent LESS. 9/10 cases were completed successfully. All had negative margins. Mean operative time was 161 minutes, estimated blood loss was 125 mL, and incision size was 4.4 cm. Median tumor size for LESS-RN and -PN was 5.0 and 1.7 cm (=.045. Median LESS-PN ischemia time was 24 minutes; mean preoperative/postoperative creatinine were 0.7/0.8 mg/dL (=.19. Mean pain score at discharge was 1.3. Mean preoperative, 3-, and 6-month postoperative SF-36 QoL Score was 73.8, 74.4 and 77.1 (=.222. All patients are currently alive. Conclusions. LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores. Further study is requisite.

  13. Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study.

    Science.gov (United States)

    El Hachem, Lena; Andikyan, Vaagn; Mathews, Shyama; Friedman, Kathryn; Poeran, Jashvant; Shieh, Kenneth; Geoghegan, Michael; Gretz, Herbert F

    2016-01-01

    To assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. Retrospective case-control study (Canadian Task Force classification II-2). University-affiliated community hospital. Female patients undergoing RSS or CL gynecologic procedures. Comparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Patient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p cost per case and total hospital charges. Careful case selection and judicious use of equipment are necessary to

  14. Hybrid laparoendoscopic single-site surgery of upper urinary tract with the use of mini-laparoscopic instruments: cosmetic outcome and midterm oncological outcome.

    Science.gov (United States)

    Kallidonis, Panagiotis; Kyriazis, Jason; Kamal, Wissam; Porpiglia, Francesco; Liatsikos, Evangelos

    2016-09-01

    To evaluate the efficacy of mini-laparoscopic instruments in combination with laparoendoscopic single-site surgery (LESS) instruments for the performance of oncological urological surgery. Thirty-five patients underwent oncological hybrid LESS either mini-laparoscopic-assisted LESS partial nephrectomy (LESS-PN, n = 12) or mini-laparoscopic-assisted LESS radical nephrectomy (LESS-RN, n = 23). Perioperative data were prospectively collected. The patient and observer scar assessment scale (POSAS) was used for the evaluation of the cosmetic outcome. Mean tumor size treated by LESS-PNs was 28.8 (IQR 20.5-37.3) mm. Average operative time and blood loss were 123 (IQR 112.5-145) min and 158.3 (IQR 100-200) ml, respectively. Renal artery clamping took place in seven cases. LESS-RN was performed in cases with a mean tumor size of 60 (IQR 48-71.5) mm. The average operative time was 116.8 (IQR 100-130) min. Average blood loss was 137 (IQR 100-150) ml. Complications were limited to grade II according to Clavien classification. The oncological outcome, including midterm results, was directly comparable to the literature. Patients reported low pain scores and high satisfaction in terms of postoperative scarring. The POSAS scores confirmed the excellent cosmetic outcome of hybrid LESS. The combination of mini-laparoscopic and LESS instrumentation as routine equipment of oncological surgery provided an efficient option for urologic surgery. The combination of mini-laparoscopic and LESS instruments improves the intraoperative ergonomics of LESS-PN and LESS-RN. The provided surgical and oncological outcome compares favorably to the LESS and conventional laparoscopic literature.

  15. Development of an in vivo visual robot system with a magnetic anchoring mechanism and a lens cleaning mechanism for laparoendoscopic single-site surgery (LESS).

    Science.gov (United States)

    Feng, Haibo; Dong, Dinghui; Ma, Tengfei; Zhuang, Jinlei; Fu, Yili; Lv, Yi; Li, Liyi

    2017-12-01

    Surgical robot systems which can significantly improve surgical procedures have been widely used in laparoendoscopic single-site surgery (LESS). For a relative complex surgical procedure, the development of an in vivo visual robot system for LESS can effectively improve the visualization for surgical robot systems. In this work, an in vivo visual robot system with a new mechanism for LESS was investigated. A finite element method (FEM) analysis was carried out to ensure the safety of the in vivo visual robot during the movement, which was the most important concern for surgical purposes. A master-slave control strategy was adopted, in which the control model was established by off-line experiments. The in vivo visual robot system was verified by using a phantom box. The experiment results show that the robot system can successfully realize the expected functionalities and meet the demands of LESS. The experiment results indicate that the in vivo visual robot with high manipulability has great potential in clinical application. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Laproendoscopic single site oesophageal diverticulectomy

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2013-01-01

    Full Text Available Epiphrenic divericula are uncommon disorders of the lower oesophagus, which are symptomatic in only 15-20% of cases. The optimum treatment modality for such cases remains an oesophageal diverticulectomy with long myotomy with or without an antireflux operation. Recently, this is increasingly being done through the laparoscopic approach. Here we describe the first reported case of oesophageal diverticulectomy through the laparoendoscopic single site approach. A 57-year-old man presented to us with 6 months history of dysphagia and regurgitation. Patient was investigated with upper gastrointestinal (UGI endoscopy, barium swallow, CECT chest and abdomen, oesophageal manometry and 24 hour pH study. He was diagnosed to have lower oesophageal diverticulum with mildly elevated pressure readings in manometric studies with normal peristalsis. Based on his symptoms, he was taken up for surgery. A laparoscopic transhiatal oesophageal diverticulectomy with myotomy was done through laparoendoscopic single site technique. The procedure lasted 160 min. There was no intraoperative complication. Gastrograffin study was done on postoperative day 2 following which he was started on liquids. He made an uneventful recovery and was discharged on fourth day. He remained asymptomatic on follow up. Oesophageal diverticulectomy is possible through laparoendoscopic single site approach if necessary expertise is available.

  17. The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions.

    Science.gov (United States)

    Sorokin, Igor; Canvasser, Noah E; Irwin, Brian; Autorino, Riccardo; Liatsikos, Evangelos N; Cadeddu, Jeffrey A; Rane, Abhay

    2017-10-01

    To analyze the most recent temporal trends in the adoption of urologic laparoendoscopic single-site (LESS), to identify the perceived limitations associated with its decline, and to determine factors that might revive the role of LESS in the field of minimally invasive urologic surgery. A 15 question survey was created and sent to members of the Endourological Society in September 2016. Only members who performed LESS procedures in practice were asked to respond. In total, 106 urologists responded to the survey. Most of the respondents were from the United States (35%) and worked in an academic hospital (84.9%). Standard LESS was the most popular approach (78.1%), while 14.3% used robotics, and 7.6% used both. 2009 marked the most popular year to perform the initial (27.6%) and the majority (20%) of LESS procedures. The most common LESS procedure was a radical/simple nephrectomy (51%) followed by pyeloplasty (17.3%). In the past 12 months, 60% of respondents had performed no LESS procedures. Compared to conventional laparoscopy, respondents only believed cosmesis to be better, however, this enthusiasm waned over time. Worsening shifts in enthusiasm for LESS also occurred with patient desire, marketability, cost, safety, and robotic adaptability. The highest rated factor to help LESS regain popularity was a new robotic platform. The decline of LESS is apparent, with few urologists continuing to perform procedures attributed to multiple factors. The availability of a purpose-built robotic platform and better instrumentation might translate into a renewed future interest of LESS.

  18. Laparoendoscopic single-site surgery with hysterectomy in patients with prior cesarean section: comparison of surgical outcomes with bladder dissection techniques.

    Science.gov (United States)

    Jo, Eun Ju; Kim, Tae-Joong; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

    2013-01-01

    The aim of this study was to compare operative outcomes from 300 patients who underwent laparoendoscopic single-site surgery (LESS) with hysterectomy (H) according to previous cesarean section and to describe the bladder dissection technique in detail. Retrospective cohort study (Canadian task classification II-2). A university hospital, research hospital, and a tertiary care center. In total, 300 LESS-H procedures were performed for benign gynecologic disease, cervical disease, and endometrial disease at Samsung Medical Center in Seoul, Korea, between May 2008 and February 2012. Patients were categorized into 2 groups according to previous cesarean history: the previous cesarean section group (n = 98) and the no history of previous cesarean section group (n = 202). LESS-H with vaginal or lateral approach for bladder dissection. Baseline demographics and clinical characteristics, except for age, were generally the same between the 2 groups. The operative outcomes including operative time, uterine weight, estimated blood loss, hemoglobin change, hospital stay, and transfusion rate were not different between the 2 groups. Adhesiolysis was required more in the previous cesarean section group (p = .002). LESS failure requiring additional trocars occurred more often in the previous cesarean section group (p = .041), but the rates of conversion to laparotomy were not different (p = .327). The overall surgical complication rate except transfusion was 2.67% in this study. Two cases of urologic problems with ureter injury or bladder injury were reported in the previous cesarean section group. In the no previous cesarean section group, there were 2 urologic problems. LESS-H is a feasible procedure with a lateral approach or vaginal approach for bladder dissection, even in patients with previous cesarean section. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  19. Laparoendoscopic single-site (LESS retroperitoneal partial adrenalectomy using a custom-made single-access platform and standard laparoscopic instruments: Technical considerations and surgical outcomes

    Directory of Open Access Journals (Sweden)

    Chen-Hsun Ho

    2015-01-01

    Conclusion: Our results clearly demonstrate that LESS retroperitoneal partial adrenalectomy can be performed safely and effectively using a custom-made single-access platform and standard laparoscopic instruments.

  20. Urologic surgery laparoscopic access: vascular complications.

    Science.gov (United States)

    Branco, Anibal Wood

    2017-01-01

    Vascular injury in accidental punctures may occur in large abdominal vessels, it is known that 76% of injuries occur during the development of pneumoperitoneum. The aim of this video is to demonstrate two cases of vascular injury occurring during access in laparoscopic urologic surgery. The first case presents a 60-year old female patient with a 3cm tumor in the superior pole of the right kidney who underwent a laparoscopic partial nephrectomy. After the Verres needle insertion, output of blood was verified. During the evaluation of the cavity, a significant hematoma in the inferior vena cava was noticed. After the dissection, a lesion in the inferior vena cava was identified and controlled with a prolene suture, the estimated bloos loss was 300ml. The second case presents a 42-year old female live donor patient who had her right kidney selected to laparoscopic live donor nephrectomy. After the insertion of the first trocar, during the introduction of the 10mm scope, an active bleeding from the mesentery was noticed. The right colon was dissected and an inferior vena cava perforation was identified; a prolene suture was used to control the bleeding, the estimated blood loss was 200mL, in both cases the patients had no previous abdominal surgery. Urologists must be aware of this uncommon, serious, and potentially lethal complication. Once recognized and in the hands of experienced surgeons, some lesions may be repaired laparoscopically. Whenever in doubt, the best alternative is the immediate conversion to open surgery to minimize morbidity and mortality. Copyright® by the International Brazilian Journal of Urology.

  1. Current status of pediatric minimal access surgery at Sultan Qaboos ...

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 4 (2013) >. Log in or Register to get access to full text downloads.

  2. Access to specialized surgical care | Saidi | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 1 (2016) >. Log in or Register to get access to full text downloads.

  3. Minimal access surgery for multiorgan hydatid cysts

    Directory of Open Access Journals (Sweden)

    Parelkar Sandesh

    2010-01-01

    Full Text Available Multiorgan hydatid cysts caused by larval growth of Echinococcus granulosus, is a rare condition in paediatric age group. There are very few reports of management of multiorgan hydatid cysts, involving lung, liver, and spleen by minimally invasive approach in paediatric age group. Herewith, we are reporting a case of hydatid cysts involving lung, liver, and spleen in a six-year-old child managed by minimally invasive surgery along with the review of literature.

  4. First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform.

    Science.gov (United States)

    Mattevi, D; Luciani, L G; Vattovani, V; Chiodini, S; Puglisi, M; Malossini, G

    2017-07-07

    This study aimed at reporting our first experience with robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with single-site VesPa platform (Intuitive Surgical Inc.). A 68-year-old-man presenting with a cT1c adenocarcinoma Gleason Score 3 + 4 = 7 in 4/12 bilateral cores underwent a transperitoneal robotic LESS-RP with a single-site Vespa platform. Initial PSA, prostate weight, and body mass index (BMI) were 4.4 ng/ml, 45 g, and 25, respectively. Instruments and camera cross within the Single-Site port; the da Vinci System software detects and reassigns the user's hands with the instruments position. The single-site port is inserted through a 2-cm intraumbilical incision. The robotic 8.5 mm scope and two surgical curved instruments (fenestrated bipolar forceps and cautery hook) are introduced through the ports and used for most of the procedure, whereas a wristed needle driver on the right hand is used for the reconstructive steps. An additional 12 mm port (Air Seal, SurgiQuest) is placed in a midline between the umbilicus and the right iliac spine in order to facilitate table assistance during surgery and to place a drain at the end of the procedure.Operative time and blood loss were 300 min and 400 mL, respectively. The postoperative course was uneventful. The drain and the catheter were removed on days 1 and 6, respectively. The patient experienced a temporary mild stress incontinence (one pad at sixth month) and erectile dysfunction.Our first robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with the single-site VesPa platform was associated with acceptable operative times and perioperative outcome. This procedure is feasible without complications, provided that a proper patient selection has occurred. Limited movements together with the lack of the fourth robotic arm require a considerable expertise in robotic surgery. Some tricks can help overcome technical limitations. The Robotic LESS-RP reduces in some

  5. Current status of pediatric minimal access surgery at Sultan Qaboos ...

    African Journals Online (AJOL)

    Objective The objective of this study was to determine the current practices of pediatric minimal access surgery (MAS) in our institute over a period of 3 years. Background data Pediatric MAS has received recognition among pediatric surgeons and is currently being practiced in most centers worldwide. However, studies in ...

  6. Current status of pediatric minimal access surgery at Sultan Qaboos ...

    African Journals Online (AJOL)

    Objective The objective of this study was to determine the current practices of pediatric minimal access surgery. (MAS) in our institute over a period of 3 years. Background data Pediatric MAS has received recognition among pediatric surgeons and is currently being practiced in most centers worldwide. However, studies in ...

  7. Robotic single-site pelvic lymphadenectomy.

    Science.gov (United States)

    Tateo, Saverio; Nozza, Arrigo; Del Pezzo, Chiara; Mereu, Liliana

    2014-09-01

    To examine the feasibility of performing pelvic lymphadenectomy with robotic single site approach. Recent papers described the feasibility of robotic-single site hysterectomy [1-3] for benign and malign pathologies but only with the development of new single site 5mm instruments as the bipolar forceps, robotic single site platform can be safely utilized also for lymphadenectomy. A 65 year-old, multiparous patient with a body mass index of 22.5 and diagnosed with well differentiated adenocarcinoma of the endometrium underwent a robotic single-site peritoneal washing, total hysterectomy, bilateral adnexectomy and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2,5 cm umbilical incision, with a multi-channel system and two single site robotic 5mm instruments. A 3-dimensional, HD 8.5mm endoscope and a 5mm accessory instrument were also utilized. Type I lymphonodes dissection for external iliac and obturator regions was performed [4]. Total operative time was 210 min; incision, trocar placement and docking time occurring in 12 min. Total console time was 183 min, estimated blood loss was 50 ml, no intra-operative or post-operative complications occurred. Hospital discharge occurred on post operative day 2 and total number of lymphnodes removed was 33. Difficulties in term of instrument's clashing and awkward motions have been encountered. Robotic single-site pelvic lymphadenectomy using bipolar forceps and monopolar hook is feasible. New developments are needed to improve surgical ergonomics and additional studies should be performed to explore possible benefits of this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. [Worldwide access to surgery: a necessity, not a luxury].

    Science.gov (United States)

    Hendriks, Thom C C; Botman, Matthijs; Voorhoeve, Roeland

    2015-01-01

    Many people in developing countries lack access to basic surgical care. This lack of access leads to preventable mortality and disability. Mortality due to surgically treatable conditions currently exceeds that due to HIV, TB and malaria combined. However, efforts by global healthcare organisations to address this problem remain limited. Essential surgery consist of basic surgical interventions that can save lives and prevent disability. It involves a limited number of interventions, is cost-effective and can be implemented sustainably in national healthcare systems. Essential surgery should therefore be accessible to everyone worldwide. In this article we discuss why it has received insufficient attention as a component of global healthcare. We also look at initiatives that aim to change this status quo.

  9. Single-Access Laparoscopic Surgery for Ileal Disease

    Directory of Open Access Journals (Sweden)

    Mohamed Moftah

    2012-01-01

    Full Text Available Aim. Single-access laparoscopic surgery (SALS can be effective for benign and malignant diseases of the ileum in both the elective and urgent setting. Methods. Ten consecutive, nonselected patients with ileal disease requiring surgery over a twelve month period were included. All had a preoperative abdominopelvic computerized tomogram. Peritoneal access was achieved via a single transumbilical incision and a “surgical glove port” utilized as our preferred access device. With the pneumoperitoneum established, the relevant ileal loop was located using standard rigid instruments. For ileal resection, anastomosis, or enterotomy, the site of pathology was delivered and addressed extracorporeally. Result. The median (range age of the patients was 42.5 (22–78 years, and the median body mass index was 22 (20.2–28 kg/m2. Procedures included tru-cut biopsy of an ileal mesenteric mass, loop ileostomy and ileotomy for impacted gallstone extraction as well as ileal (=3 and ileocaecal resection (=4. Mean (range incision length was 2.5 (2–5 cm. All convalescences were uncomplicated. Conclusions. These preliminary results show that SALS is an efficient and safe modality for the surgical management of ileal disease with all the advantages of minimal access surgery and without requiring a significant increase in theatre resource or cost or incurring extra patient morbidity.

  10. Laparoendoscopic single-site cholecystectomy in a pregnant patient

    Directory of Open Access Journals (Sweden)

    Ramya Ranjan Behera

    2013-01-01

    Full Text Available Feasibility and safety of laparoscopic cholecystectomy during pregnancy for patients with symptomatic or complicated gallstone disease is well established. Laparoendoscopic single-site cholecystectomy (LESS-chole is a new modality in which the entire surgery is undertaken via a transumbilical incision. We describe a 33-year-old patient who underwent a LESS-chole in the 20 th week of pregnancy for gallstone disease complicated by episodes of obstructive jaundice and acute pancreatitis. This is the first reported case of LESS-chole performed using conventional laparoscopic instruments. The technical aspects as well as the various perioperative measures utilized to undertake this procedure safely are outlined.

  11. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases

    DEFF Research Database (Denmark)

    Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels

    2011-01-01

    Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined.......Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined....

  12. Improving access to oral surgery services in primary care.

    Science.gov (United States)

    Kendall, Nick

    2009-10-01

    This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

  13. Complications of Minimally Invasive, Tubular Access Surgery for Cervical, Thoracic, and Lumbar Surgery

    Directory of Open Access Journals (Sweden)

    Donald A. Ross

    2014-01-01

    Full Text Available The object of the study was to review the author’s large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases (n=1231 were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases. There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery.

  14. Robotic and minimal access surgery: technology and surgical outcomes of radical prostatectomy for prostate cancer.

    Science.gov (United States)

    Müller, Stig; Grønning, Leif Erik; Nilsen, Frode S; Mygland, Vegard; Patel, Hiten R H

    2014-11-01

    Since the 1990s, minimal access surgery has been utilized in urology. In the past 15 years, robotic surgery has evolved and become a natural part of minimal access surgery. The dissemination has been fast and the opportunity of prospective trials has been missed. Nevertheless, robotic surgery has obvious benefits for the surgeon and patient. Even though the scientific evidence is not strong, robotic surgery is here to stay. However, there are lessons to learn from the implementation of the da Vinci system with regards to patient safety and prospective evaluation of the new technology. The future of surgery will include technologies derived from robotic surgery.

  15. Single-site robotic cholecystectomy: efficiency and cost analysis.

    Science.gov (United States)

    Buzad, Francis A; Corne, Louis M; Brown, Thomas C; Fagin, Randy S; Hebert, April E; Kaczmarek, Charles A; Pack, Angie N; Payne, Thomas N

    2013-09-01

    Single-incision surgery has gained in popularity, and the recent development of specialized robotic and laparoscopic instruments may remove some of the ergonomic and technical difficulties associated with this approach. However, questions of cost and efficiency remain. We prospectively collected perioperative outcome and efficiency (operative time, case volume) data for our single-site robotic cholecystectomy cases and retrospectively reviewed data for our single-incision laparoscopic cholecystectomy cases. There were no differences in patient characteristics or perioperative outcomes between the robotic (n = 20) and laparoscopic (n = 10) groups; operative times were equivalent (84.6 vs 85.5 min; p = 0.8737) and blood loss and complications were minimal. There was a higher robotic case volume, with an average of two robotic cases (range 1-4)/day vs one/day for laparoscopic cases (range 1-1; p = 0.0306). Streamlined instrument costs were essentially equivalent. Robotic single-site cholecystectomy is a safe, cost-effective alternative to single-incision laparoscopic cholecystectomy in a robot-existing model. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Minimal-access surgery training in the Netherlands: a survey among residents-in-training for general surgery

    NARCIS (Netherlands)

    Schijven, M. P.; Berlage, J. T. M.; Jakimowicz, J. J.

    2004-01-01

    BACKGROUND: The purpose of this study was to assess the state of surgical training and its possible shortcomings in minimal-access surgery (MAS) among Dutch surgical residents. METHODS: A pretested questionnaire was distributed to all residents-in-training for general surgery in The Netherlands.

  17. Disparities in access to emergency general surgery care in the United States.

    Science.gov (United States)

    Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

    2018-02-01

    As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

  19. Development of a new access device for transgastric surgery.

    Science.gov (United States)

    Swanstrom, Lee L; Kozarek, Richard; Pasricha, Pankaj J; Gross, Steven; Birkett, Desmond; Park, Per-Ola; Saadat, Vahid; Ewers, Richard; Swain, Paul

    2005-11-01

    Flexible endoscope-based endoluminal and transgastric surgery for cholecystectomy, appendectomy, bariatric, and antireflux procedures show promise as a less invasive form of surgery. Current endoscopes and instruments are inadequate to perform such complex surgeries for a variety of reasons: they are too flexible and are insufficient to provide robust grasping and anatomic retraction. The lack of support for a retroflexed endoscope in the peritoneal cavity makes it hard to reach remote structures and makes vigorous retraction of tissues and organs difficult. There is also a need for multiple channels in scopes to allow use of several instruments and to provide traction/countertraction. Finally, secure means of tissue approximation are critical. The aim was to develop and test a new articulating flexible endoscopic system for endoluminal and transgastric endosurgery. A multidisciplinary group of gastrointestinal physicians and surgeons worked with medical device engineers to develop new devices and instruments. Needs assessments and design parameters were developed by consensus. Prototype devices were tested using inanimate models until usable devices were arrived at. The devices were tested in nonsurvival pigs and dogs. The devices were accessed through an incision in the wall of the stomach and manipulated in the peritoneal cavity to accomplish four different tasks: right upper quadrant wedge liver biopsy, right lower quadrant cecal retraction, left lower quadrant running small bowel, and left lower quadrant exposure of esophageal hiatus. In another three pigs, transgastric cholecystectomy was attempted. The positions of the device, camera, and endosurgical instruments, with and without ShapeLock technology, were recorded using laparoscopy and endoscopy and procedure times and success rates were measured. Instrument design parameters and their engineering solutions are described. Flexible multilumen guides which could be locked in position, including a prototype

  20. Relationship Between Periodontal Screening and Recording Index Scores and Need for Periodontal Access Surgery.

    Science.gov (United States)

    Rams, Thomas E; Loesche, Walter J

    2017-10-01

    The validity of using pretreatment Periodontal Screening and Recording (PSR) index sextant scores to estimate periodontal access surgery needs is evaluated in patients with chronic periodontitis before and after completion of non-surgical periodontal therapy. In 110 adults, pretreatment probing data identified 486 sextants with PSR scores of 4 and 125 sextants with PSR scores of 3. Periodontal access surgery needs for all sextants were determined prior to treatment and after completion of non-surgical periodontal therapy for 213 sextants in 38 patients by two experienced periodontist examiners. PSR scores of 4 identified untreated sextants with periodontal access surgery needs significantly better than PSR scores of 3 (odds ratio = 27.8; P periodontal access surgery need continued to have surgical access needs after completion of non-surgical periodontal therapy. A higher percentage of sextants with PSR scores of 4 or 3 revealed periodontal access surgical needs when Class II or III furcation involvements and/or Grade II or III tooth mobility were also detected in the sextant than when these parameters were not detected. Pretreatment PSR index scores of 4 were a strong indicator of periodontal access surgery needs in untreated dentition sextants but markedly overestimated surgical access needs remaining after completion of non-surgical periodontal therapy. These findings raise questions about the usefulness of pretreatment PSR evaluations for estimating potential periodontal access surgery needs in patients to be initially treated with non-surgical periodontal therapy.

  1. Editorial The Evolution of Minimal Access Surgery and the ...

    African Journals Online (AJOL)

    KIGZ

    . Ndungu BM. School of Medicine, University of Nairobi. Surgery is the first and the highest division of the healing art, pure in itself and perpetual in its applicability (1). In its history, large incisions were an absolute necessity to a successful.

  2. Cardiac safety in vascular access surgery and maintenance.

    Science.gov (United States)

    Malik, Jan; Kudlicka, Jaroslav; Tesar, Vladimir; Linhart, Ales

    2015-01-01

    More than 50% of all end-stage renal disease (ESRD) patients die from cardiovascular complications. Among them, heart failure and pulmonary hypertension play a major role, and published studies document significantly higher mortality rates in patients with these two states. Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred types of vascular access (VA). However, both AVF and AVG increase cardiac output and in turn could contribute to (the decompensation of) heart failure or pulmonary hypertension. No really safe access flow volume exists, and the ESRD patients' reactions to it vary considerably. We review the mechanisms involved in the cardiovascular consequences of increased cardiac output and available literary data. The link between access flow volume and increased mortality due to pulmonary hypertension or heart failure probably exists, but still has not been directly evidenced. Regular echocardiography is advisable especially in patients with symptoms or with high VA flow (>1,500 ml/min). © 2015 S. Karger AG, Basel.

  3. Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

    Science.gov (United States)

    Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T

    2016-08-01

    The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

  4. Accessibility to editorial information in Oral and Maxillofacial Surgery journals: The authors' point of view.

    Science.gov (United States)

    Castelo-Baz, Pablo; Leira-Feijoo, Yago; Seoane-Romero, Juan Manuel; Varela-Centelles, Pablo; Seoane, Juan

    2015-09-01

    To evaluate the accessibility to editorial information in Oral & Maxillofacial Surgery journals. A cross-sectional study using the WOS-Web of Science database in three categories: "Surgery," "Otorhinolaryngology," and "Dentistry, Oral Surgery & Medicine" was designed. Journals were filtered by title and classified under three headings: OMFS specialty; OMFS subspecialty and related sciences; and multidisciplinary journals. Specialty scope (OMFS vs. other); impact factor; path for the manuscript; blinding policy; accessibility to reviewers' criteria; and percentage of acceptance. Only 46 of 330 journals met the inclusion criteria. All OMFS journals provided comprehensive information about the review process, compared to 5 of 27 (18.5%) of Oral Surgery and related sciences periodicals. Most specialty journals do not inform about the blind review mode used (20 of 33; 60.6%). Generally, information about the reviewers' assessment criteria is scarce, but is available from all OMFS journals, which also state the percentage of manuscript acceptance (100% vs. 14.8%). OMFS JCR journals provide adequate information about their editorial process in terms of path for the manuscript, accessibility to reviewers' criteria, and percentage of acceptance. Additional efforts are needed to increase accessibility to information about blinding policy and average time from submission to acceptance. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Video assistance in mitral surgery: reaching the "Thru" port access.

    Science.gov (United States)

    Irace, Francesco G; Rose, David; D'Ascoli, Riccardo; Caldaroni, Federica; Andriani, Ines; Piscioneri, Fernando; Vitulli, Piergiusto; Piattoli, Matteo; Tritapepe, Luigi; Greco, Ernesto

    2015-01-01

    Minimally invasive and video assisted mitral valve surgery has been used widely since beginning of 20 th . Different reduced surgical approaches allowed replacing or repairing a mitral valve sparing sternal incision. Nevertheless the most used strategy has been in the last years the right mini thoracotomy and the extra thoracic cardiopulmonary bypass (CPB). The main goal is avoiding sternal approach for mitral valve procedures and improve postoperative course of the patients. Some postoperative complication likes blood loss, need for transfusion, prolonged intubation and infection has been reduced using this alternative technique. A special advantages has been reported in elderly or high risk patients and in redo cases. Several cardiac centres using videoscopy and a revolutionary set up for CPB management and aortic occlusion have adopted the approach. The team approach, including surgeon, anaesthesiologist, nurse, cardiologist and perfusionist, is crucial for a safe and effective realization of this surgical strategy. The proper use of catheters and Seldinger skilfulness, and the guidance of trans-esophageal echocardiography (TEE) during the procedure are two milestones of this technique. A careful and progressive learning curve is required for all the components of the team. In fact some peculiarity likes modified surgical instruments, 3D and Full HD video assisted view, percutaneous canulation for CPB and myocardial protection, etc., make this procedure challenging for all members of the operative room (OR) team. Our favourite set-up include right mini thoracotomy in the IV intercostal space, femoral vein and arterial canulation and an additional venous cannula in the superior vena cava for the drainage of the upper part of the body. Aortic occlusion is achieved usually using an endo-aortic clamp positioned by means of continuous and careful TEE guidance. A mitral valve procedure is realized by direct or video guided view; using adapted and shaft instruments or

  6. Limited access atrial septal defect closure and the evolution of minimally invasive surgery.

    Science.gov (United States)

    Izzat, M B; Yim, A P; El-Zufari, M H

    1998-04-01

    While minimizing the "invasiveness" in general surgery has been equated with minimizing "access", what constitutes minimally invasive intra-cardiac surgery remains controversial. Many surgeons doubt the benefits of minimizing access when the need for cardiopulmonary bypass cannot be waived. Recognizing that median sternotomy itself does entail significant morbidity, we investigated the value of alternative approaches to median sternotomy using atrial septal defect closure as our investigative model. We believe that some, but not all minimal access approaches are associated with reduced postoperative morbidity and enhanced recovery. Our current strategy is to use a mini-sternotomy approach in adult patients, whereas conventional median sternotomy remains our standard approach in the pediatric population. Considerable clinical experiences coupled with documented clinical benefits are fundamental before a certain approach is adopted in routine practice.

  7. Experiences of accessing obesity surgery on the NHS: a qualitative study.

    Science.gov (United States)

    Owen-Smith, Amanda; Donovan, Jenny; Coast, Joanna

    2017-03-01

    Although surgical treatment is recommended for morbid obesity where other interventions have failed, there is evidence that access to NHS surgery is heavily rationed. This study aimed to investigate how patients experienced accessing referrals for obesity surgery. Data collection was undertaken using in-depth interviews with patients and clinicians working in a specialist secondary care facility, and analysis took a constant comparative approach. Twenty-two participants with morbid obesity were followed up for a period of up to 3 years. All participants had made multiple attempts to lose weight prior to consulting their GPs yet felt this was rarely acknowledged by clinicians. Participants were frustrated when they received insufficient support to comply with primary care interventions, and when it came to obtaining a referral to secondary care, most had to raise this issue with GPs themselves. There is an urgent need for interventions for morbid obesity in primary care that are accessible to patients to facilitate weight loss and prevent weight re-gain. For those at very high weights, better integration between primary and secondary care is required to ensure appropriate and timely referral for those who need assessment for surgery. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Energy consumption during simulated minimal access surgery with and without using an armrest.

    Science.gov (United States)

    Jafri, Mansoor; Brown, Stuart; Arnold, Graham; Abboud, Rami; Wang, Weijie

    2013-03-01

    Minimal access surgery (MAS) can be a lengthy procedure when compared to open surgery and therefore surgeon fatigue becomes an important issue and surgeons may expose themselves to chronic injuries and making errors. There have been few studies on this topic and they have used only questionnaires and electromyography rather than direct measurement of energy expenditure (EE). The aim of this study was to investigate whether the use of an armrest could reduce the EE of surgeons during MAS. Sixteen surgeons performed simulated MAS with and without using an armrest. They were required to perform the time-consuming task of using scissors to cut a rubber glove through its top layer in a triangular fashion with the help of a laparoscopic camera. Energy consumptions were measured using the Oxycon Mobile system during all the procedures. Error rate and duration time for simulated surgery were recorded. After performing the simulated surgery, subjects scored how comfortable they felt using the armrest. It was found that O(2) uptake (VO(2)) was 5 % less when surgeons used the armrest. The error rate when performing the procedure with the armrest was 35 % compared with 42.29 % without the armrest. Additionally, comfort levels with the armrest were higher than without the armrest. 75 % of surgeons indicated a preference for using the armrest during the simulated surgery. The armrest provides support for surgeons and cuts energy consumption during simulated MAS.

  9. Single-site neural tube closure in human embryos revisited.

    Science.gov (United States)

    de Bakker, Bernadette S; Driessen, Stan; Boukens, Bastiaan J D; van den Hoff, Maurice J B; Oostra, Roelof-Jan

    2017-10-01

    Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. Access to elective surgery at electoral ward level: the impact of the private sector.

    Science.gov (United States)

    Lamden, K H; Sudell, A J

    1995-03-01

    Purchasers of health care receive no routine information on the use of the private health sector by their residents, and are consequently unaware of any resulting differentials in access to health services. This information would assist in assessing need for services on a locality basis. For the period 1990-1992 surgical activity data from the single private hospital in Preston were examined by electoral ward of residence and compared with corresponding NHS data. For the procedures examined, the private sector contributed only 8 per cent to overall surgical activity within Preston. People from the more affluent wards were far more likely to use the private sector than those from deprived wards. The private sector did not introduce any inequity of access to surgery within Preston at electoral ward level. However, in districts with higher levels of private sector activity significant differentials in access may exist.

  11. Direct partial oxidation of methane via single-site chemistry

    Science.gov (United States)

    Kakekhani, Arvin; Norskov, Jens

    Methane (CH4), the cheapest source of hydrocarbons, is a difficult-to-store and hard-to-convert chemical, due to strong and isotropic C-H bonds. Having a selective and efficient method to partially oxidize methane into more useful chemicals including methanol, formaldehyde and alkenes has long been an open challenge for catalysis community. The main challenge is selectivity: if a catalytic material interacts strongly with methane, sufficient to break one C-H bond, it breaks all other bonds of the derivative molecules, as well. This leads to over-oxidization to CO2. Here using density functional theory (DFT) modelings, we discuss the possibility of using defective (vacancy rich) 2-d materials e.g., MoS2 to effectively trap single transition metal atoms; thereby, creating a single-site chemistry to enhance the selectivity of methane oxidation process. A single-site chemistry leads to competition between intermediates and products for limited active sites. Our strategy is to use this as an effective means to block unwanted reaction pathways leading to over-oxidization. United States department of energy.

  12. Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?

    Science.gov (United States)

    Son, Andrew; Mannoia, Kristyn; Herrera, Anthony; Chizari, Mohammad; Hagdoost, Muhammad; Molkara, Afshin

    2016-05-01

    Creation of an arteriovenous fistula (AVF) is the preferred method of establishing long-term dialysis access. There are multiple anesthetic techniques used for patients undergoing this surgery including general endotracheal intubation, laryngeal mask airway, regional anesthesia with nerve blocks, and monitored anesthesia care with local infiltration. It is unclear what effect the method of anesthesia has on AVF creation success rate. It is our objective to determine if anesthesia type affects success of these surgeries defined by complication and maturation rates. A retrospective review was performed in a single institution, single surgeon study of 253 patients who underwent AVF creation between January 2003 and December 2010. Patients were cross analyzed between 3 anesthesia types (General Endotracheal Intubation, Laryngeal Mask Airway and Local Infiltration with Monitored Anesthesia Care) and AVF creation surgeries (radiocephalic, brachiocephalic, and basilic vein transposition). No patients had regional anesthesia performed. Demographic data including comorbidities and risk factors were stratified among all categories. Analysis of variance, chi-squared testing, and Fisher's exact P testing was performed across all anesthesia types and specific operations and measured according to success of fistula maturation and complication rates (including death within 30 days, myocardial infarction within 30 days, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome). There were no significant differences in maturation rate in terms of all 3 anesthesia types for radiocephalic (P = 0.191), brachiocephalic (P = 0.191), and basilic vein transposition surgeries (P = 0.305). In addition, there were no differences in complication rates between the surgeries and the 3 types of anesthesia (P = 0.557). Our study shows that despite anesthesia type, outcomes in terms of maturation and complication rate are not statistically

  13. Validation of virtual reality simulators: Key to the successful integration of a novel teaching technology into minimal access surgery

    NARCIS (Netherlands)

    Schijven, Marlies P.; Jakimowicz, Jack J.

    2005-01-01

    Minimal access surgery (MAS) requires additional training in the surgical curriculum, as skills needed to perform MAS are quite different from those used in open surgery. Moreover, residents do not seem to experience ample opportunity to gain such skills in the current surgical curriculum. Virtual

  14. Open Access Publishing: A Study of Current Practice in Oral and Maxillofacial Surgery Research.

    Science.gov (United States)

    Tahim, Arpan; Bansal, Hitesh; Goodson, Alexander M C; Payne, Karl F B; Sabharwal, Sanjeeve

    2016-12-01

    Open access (OA) publication has become an increasingly common route for dissemination of scientific research findings. However, it remains a contentious issue with continued debate as to its impact on the peer-review process and a potential change in the quality of subsequent evidence published. There is little research that looks into OA in oral and maxillofacial surgery. We investigated the OA policy in the 30 relevant journals listed in the Institute for Scientific Information Web of Knowledge journal citation report, comparing bibliometric data and quality of evidence produced in journals offering OA and those with subscription-only policies. 3474 articles were graded for evidence level and the results correlated to journal OA status. 76.7 % of journals offered authors OA services. There was no difference between impact factor, self-citation rate, total citations or quality of evidence between OA and subscription journals. These findings should send clear messages to both clinicians and researchers and should re- assure readers that scientific findings that are disseminated in open access form do not differ in quality to those in subscription-only format. It should reinforce that open access formats are a credible way to display research findings in oral and maxillofacial surgery.

  15. Ergon-trial: ergonomic evaluation of single-port access versus three-port access video-assisted thoracic surgery.

    Science.gov (United States)

    Bertolaccini, Luca; Viti, Andrea; Terzi, Alberto

    2015-10-01

    Single-port access video-assisted thoracic surgery (VATS), a technique progressively developed from the standard three-port approach in minimally invasive surgery, offers ergonomic advantages but also new challenges for the surgeon. We compared the ergonomics of three-port versus single-port VATS. Posture analysis of surgeons was evaluated during 100 consecutive VATS wedge resections (50 triportal vs. 50 uniportal). Technically demanding procedures (major lung resection) were excluded. Operating table height, monitor height, distance and inclination were adjusted according to operator preference. Body posture was assessed by measuring head-trunk axial rotation and head flexion. Perceived physical strain was self-evaluated on the Borg Category Ratio (CR-10) scale. Mental workload was assessed with the National Aeronautics Space Administration-Task Load indeX (NASA-TLX), a multidimensional tool that rates workloads on six scales (mental, physical and temporal demand; effort; performance; frustration). All procedures were completed without complications. Head-trunk axial rotation was significantly reduced and neck flexion significantly improved in uniportal VATS. Viewing direction significantly declined (p = 0.01), body posture as measured on the Borg CR-10 scale was perceived as more stressful and the NASA-TLX score for overall workload was higher (p = 0.04) during triportal VATS. The NASA-TLX score for frustration was higher with uniportal VATS (p = 0.02), but the score for physical demand was higher in triportal VATS (p = 0.006). The surgeon can maintain a more neutral body posture during uniportal VATS by standing straight and facing the monitor with only minimal neck extension/rotation; however, frustration is greater than with triportal VATS.

  16. Wegner Estimates for Sign-Changing Single Site Potentials

    Science.gov (United States)

    Veselić, Ivan

    2010-12-01

    We study Anderson and alloy-type random Schrödinger operators on ℓ2(ℤ d ) and L 2(ℝ d ). Wegner estimates are bounds on the average number of eigenvalues in an energy interval of finite box restrictions of these types of operators. For a certain class of models we prove a Wegner estimate which is linear in the volume of the box and the length of the considered energy interval. The single site potential of the Anderson/alloy-type model does not need to have fixed sign, but it needs be of a generalised step function form. The result implies the Lipschitz continuity of the integrated density of states.

  17. Intramolecular electron transfer in single-site-mutated azurins

    DEFF Research Database (Denmark)

    Farver, O; Skov, L K; Pascher, T

    1993-01-01

    . Natl. Acad. Sci. U.S.A. 86, 6968-6972]. The RSSR- radical produced in the above reaction was reoxidized in a slower intramolecular electron-transfer process (30-70 s-1 at 298 K) concomitant with a further reduction of the Cu(II) ion. The temperature dependence of the latter rates was determined...... and used to derive information on the possible effects of the mutations. The substitution of residue Phe114, situated on the opposite side of Cu relative to the disulfide, by Ala resulted in a rate increase by a factor of almost 2. By assuming that this effect is only due to an increase in driving force......Single-site mutants of the blue, single-copper protein, azurin, from Pseudomonas aeruginosa were reduced by CO2- radicals in pulse radiolysis experiments. The single disulfide group was reduced directly by CO2- with rates similar to those of the native protein [Farver, O., & Pecht, I. (1989) Proc...

  18. Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg

    2012-01-01

    Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefits...

  19. Management of gallbladder duplication using a single-site robotic-assisted approach: a case study.

    Science.gov (United States)

    Boyle, Melanie Adams; Kaplin, Aviva Wallace; Kushnir, Leon; Montero-Pearson, Per

    2016-06-01

    Gallbladder duplication is a rare congenital anomaly. Here, we describe a 29-year-old female who presents with classic symptoms of biliary colic. A duplicated gallbladder was recognized on preoperative ultrasound. This case report reviews a single-site robotic-assisted cholecystectomy with a cystic duct duplication. The patient underwent the surgery without complication. Due to the aberrant anatomy of the cystic triangle, it was decided to mobilize the gallbladder in a dome-down fashion. True gallbladder duplication can be categorized according to cystic duct orientation based on Boyden's classification. Preoperative diagnosis is essential to prevent surgical complications. A laparoscopic approach can be carried out safely in the hands of a skilled surgeon. This case report shows that the robotic-assisted surgical approach is a viable and safe alternative.

  20. A stable rhodium single-site catalyst encapsulated within dendritic mesoporous nanochannels.

    Science.gov (United States)

    Tian, Jun; Yang, Dali; Wen, Jianguo; Filatov, Alexander S; Liu, Yuzi; Lei, Aiwen; Lin, Xiao-Min

    2018-01-18

    Catalysis plays an essential role in the modern chemical industry. However, it still remains a great challenge to improve the efficiency of many heterogeneous catalysts based on a per metal atom basis. Single-site catalysts (SsCs) with isolated metal atoms/ions anchored to the supports are thus highly desirable, providing an innovative solution towards highly efficient usage of precious metal atoms in heterogeneous catalysts. Creating SsCs with high metal loading proves to be challenging because, without robust anchoring, atoms tend to diffuse to form large aggregates during catalytic reactions. We report a facile ligand exchange method to anchor a single-site Rh catalyst inside the individual channels of three-dimensional dendritic mesoporous silica nanospheres (MSNSs). The short porous channels inside MSNSs provide an easy access of reactants and the strong binding of the ligand prevents the aggregation of catalyst sites. The as-synthesized Rh 1 @MSNS-NH 2 catalyst shows excellent activity, stability and reusability in the reduction of 4-nitrophenol. The same catalyst shows high regioselectivity in the hydrosilylation of terminal alkynes to yield α-vinylsilanes through the Markovnikov addition.

  1. Single-Site Heterogeneous Catalysts: Innovations, Advantages, and Future Potential in Green Chemistry and Sustainable Technology

    Science.gov (United States)

    Raja, Robert; Thomas, John Meurig

    The advantages that flow from the availability of single-site heterogeneous catalysts are many. They facilitate the determination of the kinetics and mechanism of catalytic turnover and render accessible the energetics of various intermediates. More importantly, it is possible to prepare soluble molecular fragments that circumscribe the single site, thus enabling a direct comparison to be made between the catalytic performance of the same active site when functioning as a heterogeneous or a homogeneous catalyst. Our approach adopts the principles and practices of solid-state chemistry, augmented by lessons derived from enzymology, as well as computational chemistry. We have succeeded in designing a range of new catalysts to effect, inter alia, shape-selective, regioselective, bifunctional, and enantioselective catalytic conversions. In particular, large fractions of these catalysts are ideally suited for the era of clean technology in which single-step and/or solvent-free processes abound, and in which benign oxidants such as air or oxygen and inexpensive nanoporous materials are employed.

  2. Shape memory alloy fixator system for suturing tissue in minimal access surgery.

    Science.gov (United States)

    Xu, W; Frank, T G; Stockham, G; Cuschieri, A

    1999-01-01

    A new technique for suturing human tissue is described in which tissue closure is achieved by means of small fixators made from shape memory alloy. The aim of the development is to provide an alternative to thread suturing in minimal access surgery, which is quicker and requires less skill to achieve the required suturing quality. The design of the fixators is described in terms of the thermal shape recovery of shape memory alloy and a novel form of finite element analysis, which uses a nonlinear elastic element for the material property. Thermal analysis of the fixators and surrounding tissue is used to predict the temperature distribution during and after the application of electric current heating. This was checked in an in vitro experiment, which confirmed that deployment caused no detectable collateral damage to surrounding tissue. In vivo animal studies on the use of the shape memory alloy fixator for suturing tissue are ongoing to establish safety and healing effects.

  3. Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery.

    Science.gov (United States)

    Leroux, Eric J; Morton, John M; Rivas, Homero

    2014-08-01

    To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

  4. Evaluating Progress in the Global Surgical Crisis: Contrasting Access to Emergency and Essential Surgery and Safe Anesthesia Around the World.

    Science.gov (United States)

    Merchant, Amina; Hendel, Simon; Shockley, Ross; Schlesinger, Joseph; Vansell, Hilary; McQueen, Kelly

    2015-11-01

    Since 2007, observations reveal that low- and middle-income countries (LICs and LMICs) experience similar surgical access and safety issues, though the etiology of these challenges varies by country. The collective voice of surveys completed to date has pushed the agenda for the inclusion of safe surgery and anesthesia within global health discussions. Comparison of four countries across the world shows similar basic progress as well as ongoing surgical and anesthesia needs in resource-challenged countries. By studying these common needs, a comprehensive plan to provide infrastructure and personnel support can work in multiple austere settings. A standardized survey tool published, designed, and developed initially by the Harvard Humanitarian Initiative and modified at Vanderbilt University was completed in Guatemala, Guyana, Laos, and Mozambique. The survey assessed eight key areas of essential surgical care: access to and availability of surgical services, access to human resources, essential infrastructure (including access to water, electricity, sanitation, blood products, and essential medicines including supplemental oxygen), surgical outcomes, operating room information and procedures, equipment, International Organization, and Non-Government Organization provision of surgical care. These results were compared and contrasted to evaluate resource challenges and assets in each country. A total of 49 hospitals were surveyed in this comparison cohort. The results reveal common needs for emergency and essential surgery in each country, but some differences in human and capital resources exist. While minimal resources exist, all surgical sites provided running water, electricity, and oxygen-assets not seen in previous surveys as recent as 2011. The most basic needs to provide essential surgery are now present in LICs and LMICs. Many more resources are needed to ensure access to safe surgery and anesthesia. The next steps to provide essential surgery must include

  5. Single-site ventricular pacing via the coronary sinus in patients with tricuspid valve disease.

    Science.gov (United States)

    Noheria, Amit; van Zyl, Martin; Scott, Luis R; Srivathsan, Komandoor; Madhavan, Malini; Asirvatham, Samuel J; McLeod, Christopher J

    2017-03-01

    To evaluate coronary sinus single-site (CSSS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF) when traditional right ventricular lead implantation is not feasible or is contraindicated. We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CSSS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RVSS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CSCRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up. Successful CSSS pacing was accomplished in all 23 patients without any procedural complications. During the 5.3 ± 2.8-year follow-up 22/23 (95.7%) leads were functional with stable pacing and sensing parameters, and 1/23 (4.3%) was extracted for unrelated reasons. Compared to CSSS leads, the lead revision/abandonment was similar with RVSS leads (Hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.03, 22.0), but was higher with CSCRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CSSS and RVSS groups (-2.4 ± 11.0 vs. 1.5 ± 12.8, P = 0.76), but LVEF improved in CSCRT group (11.2 ± 16.5%, P = 0.002). Fluoroscopy times were longer during implantation of CSSS compared to RVSS leads (25.6 ± 24.6 min vs. 12.3 ± 18.6 min, P = 0.049). In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  6. Minimal access surgery in newborns and small infants; five years experience

    Directory of Open Access Journals (Sweden)

    Sandesh V Parelkar

    2013-01-01

    Full Text Available Aims and Objectives: The aim of this study was to assess and present the outcome (initial experience and lessons learnt of minimally invasive surgery for various indications in neonates and small infants (< 5 kg at a single medical centre. Materials and Methods: A retrospective analysis was performed on 65 patients (age day 2 to 10 months managed with minimal access surgery (MAS for various indications, between 2005 and 2010. We analyzed demographic information, procedures, complications, outcomes, and follow-up and overall feasibility of the procedure. Results: No serious complications except one death in congenital diaphragmatic hernia (CDH (due to other comorbidities occurred. Intra operative hypercarbia and hypoxia were observed more frequently in thoracoscopic procedures. Intra operative hypothermia was not common and was well tolerated. Conversion to open procedure (n = 5, post operative ileus (n = 3, port site infection (n = 5 were other complications. Conclusion: MAS in neonates and small infants is a technically demanding but a feasible choice available. Some prior experience in older children is required for safe and effective outcome. Good quality optics, video equipments and instruments are required for safe and effective procedure. Intra operative measurement of oxygen saturation and temperature, and diligent post operative ICU care are mandatory for safe and successful outcome.

  7. Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study.

    Science.gov (United States)

    Su, Jian; Zhu, Qingyi; Yuan, Lin; Zhang, Yang; Zhang, Qingling; Wei, Yunfei

    2018-01-01

    To describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site (LESS) radical prostatectomy (RP) and LESS radical cystectomy (RC) in a single institution. Between December 2014 and March 2016, a total of 114 LESS RPs and RCs were performed, comprising 68 LESS RPs, 38 LESS RCs with cutaneous ureterostomy (CU) and eight LESS RCs with orthotopic ileal neobladder (OIN). Access was achieved via a single-port, with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port ('Zhu's port') was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The peri-operative and postoperative data were collected and analysed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects. All the procedures were completed successfully. No conversion to conventional laparoscopic surgery was necessary. For LESS RP, the average operating time was 152 min. Estimated blood loss was 117 mL. The mean hospital stay was 16.4 days after surgery. For LESS RC with CU and LESS RC with OIN, the mean operating times were 215 and 328 min, mean estimated blood loss was 175 and 252 mL, and mean hospital stay was 9.4 and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intra-operative complications occurred in two patients (1.75%), and postoperative complications in nine (7.89%). Fourteen out of 68 (20.6%) patients who underwent LESS RP had positive surgical margins. Follow-up ranged from 10 to 30.6 months. In the prostate cancer cases, good urinary control was observed in 35.3%, 97.1% and 100% of patients at 1, 6 and 12 months after the operation, respectively, while biochemical recurrence was observed in 11.8% patients. In the bladder cancer cases, two patients had local recurrence and two patients had distant metastasis. Our results showed that LESS RP and LESS RC

  8. Olefin polymerization from single site catalysts confined within porous media

    Science.gov (United States)

    Kasi, Rajeswari M.

    Single Site Catalysts (SSCs) have been utilized for olefin polymerization. Altering the metal-ligand architecture in the SSCs, polyolefin properties can be enhanced in a rational manner. This influence of the ligands in the SSC on the property of polyolefins prepared can be referred to as the primary ligand influence. Extending this understanding and subsequent control of the metal-ligand framework to the interaction of SSCs within organic and inorganic supports is vital for the synthesis of polyolefins with tailored properties. The motivation behind this thesis was to explore the support influence on the reactivity of the SSC tethered to a support matrix during ethylene homo and copolymerization. In order to address this question of the support influence on the final polyolefin properties, synthetic routes to covalently bind SSCs on different matrices have been explored. Two distinct supported SSCs have been used to prepare branched polyethylenes. Branched polyethylenes can be prepared by either copolymerization (ethylene and alpha-olefin) or oligomerization/copolymerization processes (ethylene and in situ generated alpha-olefin). Synthetic routes to prepare precursor catalysts to Constrained Geometry Catalysts (CGCs) by silyl elimination chemistry have been developed (Chapter 2). Efficient synthetic protocols to assemble CGCs on aminomethylpolysytrene matrices (Chapter 3) and amine-functionalized mesoporous silica (Chapter 4) are also reported. These supported catalysts, with appropriate cocatalysts have been used to prepare ethylene homo and copolymers, the polymer thermal properties and microstructures were analyzed by various analytical techniques. Branched polyethylenes (LLDPE) can be prepared by copolymerization chemistry. It has been observed is that the influence of the support is seen in the production of lower crystalline forms of high density polyethylene (HDPE, 20--50% crystalline), while homogeneous polymerization of analogous soluble CGCs afford HDPE

  9. Single-site robotic cholecystectomy and robotics training: should we start in the junior years?

    Science.gov (United States)

    Ayabe, Reed I; Parrish, Aaron B; Dauphine, Christine E; Hari, Danielle M; Ozao-Choy, Junko J

    2018-04-01

    It has become increasingly important to expose surgical residents to robotic surgery as its applications continue to expand. Single-site robotic cholecystectomy (SSRC) is an excellent introductory case to robotics. Resident involvement in SSRC is known to be feasible. Here, we sought to determine whether it is safe to introduce SSRC to junior residents. A total of 98 SSRC cases were performed by general surgery residents between August 2015 and August 2016. Cases were divided into groups based on resident level: second- and third-years (juniors) versus fourth- and fifth-years (seniors). Patient age, gender, race, body mass index, and comorbidities were recorded. The number of prior laparoscopic cholecystectomies completed by participating residents was noted. Outcomes including operative time, console time, rate of conversion to open cholecystectomy, and complication rate were compared between groups. Juniors performed 54 SSRC cases, whereas seniors performed 44. There were no significant differences in patient age, gender, race, body mass index, or comorbidities between the two groups. Juniors had less experience with laparoscopic cholecystectomy. There was no significant difference in mean operative time (92.7 min versus 98.0 min, P = 0.254), console time (48.7 min versus 50.8 min, P = 0.639), or complication rate (3.7% versus 2.3%, P = 0.68) between juniors and seniors. SSRC is an excellent way to introduce general surgery residents to robotics. This study shows that with attending supervision, SSRC is feasible and safe for both junior and senior residents with very low complication rates and no adverse effect on operative time. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Access to rat kidney with minimal anesthesia and surgery: a new experimental model.

    Science.gov (United States)

    Sadowski, J; Kompanowska-Jezierska, E; Walkowska, A

    1996-01-01

    Chronic surgical explantation of the left rat kidney out of the abdominal cavity under the flank skin enabled easy access to the organ and ipsilateral urine collection under light chloralose anesthesia without virtually any surgical intervention. The glomerular filtration rate, urine flow and osmolality, sodium excretion, and medullary tissue hypertonicity were similar in the explanted and in the contralateral kidney, whereas p-aminohippurate clearance was 14% lower. The function of the explanted kidney was also compared with that of the kidney acutely exposed in rats under thiobutabarbital anesthesia and rendered euvolemic by isoncotic albumin infusion. Again, in both preparations renal function was comparable except that over time urine osmolality remained stable in the former and fell from 1,385 +/- 195 to 835 +/- 167 mosmol/kgH2O (P < 0.02) in the latter, indicating deterioration of urine concentration. Laser-Doppler probes could be easily applied in the explanted kidney to measure cortical and medullary blood flow. The new experimental model offers some advantages, both over studies using conscious rats and over experiments involving deep anesthesia and acute surgery.

  11. Three-chip LED illumination system for laparoscopy and minimal access surgery applications

    Science.gov (United States)

    Ye, Bin; Wang, Liqiang; Duan, Huilong

    2010-11-01

    Light-emitting diodes (LEDs) bring great flexibility in color choice and high luminous efficacy design for biomedical illumination. Based on the state-of-the-art LED chips, a three-chip LED illumination system was developed specially for laparoscopy and minimal access surgery. White light is produced by mixing three specific wavelengths of amber red, true green and blue, and then coupled into a fiber-optic light guide with 2mm diameter. The whole device has a compact size of 145mm × 92mm × 84 mm which is more suitable than a conventional xenon lamp source for portable endoscopes. The illuminance and color characteristic of the three-chip model were analyzed, compared to those of traditional light source. A maximum illuminance of 1960 lux was obtained at the distance of 100 mm, with the average current of 450 mA of the LEDs. Additionally, a simulation environment had been set up to find out the performance of the endo-illuminator in the specific circumstance, which was closer distance and crawl space. Experiments showed that images taken under the three-chip LED illumination had better contrast and saturation. With the temperature of 31.5 degrees Celsius at the end of the fiber bundle, the endo-illuminator is also a cold light source.

  12. Effect of portal access system and surgery type on surgery times during laparoscopic ovariectomy and salpingectomy in captive African lions and cheetahs.

    Science.gov (United States)

    Hartman, Marthinus Jacobus; Monnet, Eric; Kirberger, Robert Murco; Schoeman, Johan Petrus

    2016-03-02

    A prospective randomized study was used to compare surgery times for laparoscopic ovariectomy and salpingectomy in female African lion (Panthera leo) (n = 14) and cheetah (Acinonyx jubatus) (n = 20) and to compare the use of a multiple portal access system (MPAS) and single portal access system (SPAS) between groups. Two different portal techniques were used, namely MPAS (three separate ports) in lions and SPAS (SILS™ port) in cheetahs, using standard straight laparoscopic instruments. Portal access system and first ovary was not randomized. Five different surgery times were compared for the two different procedures as well as evaluating the use and application of MPAS and SPAS. Carbon dioxide volumes for lions were recorded. In adult lionesses operative time (OPT) (P = 0.016) and total surgical time (TST) (P = 0.032) were significantly shorter for salpingectomy compared to ovariectomy. Similarly in cheetahs OPT (P = 0.001) and TST (P = 0.005) were also shorter for salpingectomy compared to ovariectomy. In contrast, in lion cubs no difference was found in surgery times for ovariectomy and salpingectomy. Total unilateral procedure time was shorter than the respective bilateral time for both procedures (P = 0.019 and P = 0.001) respectively and unilateral salpingectomy was also faster than unilateral ovariectomy (P = 0.035) in cheetahs. Port placement time, suturing time and TST were significantly shorter for SPAS compared to MPAS (P = 0.008). There was, however, no difference in OPT between SPAS and MPAS. Instrument cluttering with SPAS was found to be negligible. There was no difference in mean volume CO2 required to complete ovariectomy in lions but the correlation between bodyweight and total volume of CO2 in lions was significant (rs = 0.867; P = 0.002). Laparoscopic salpingectomy was faster than ovariectomy in both adult lions and cheetahs. Using SPAS, both unilateral procedures were faster than bilateral procedures in cheetahs

  13. Design and evaluation of a variable stiffness manual operating platform for laparoendoscopic single site surgery (LESS).

    Science.gov (United States)

    Li, Jinhua; Li, Xuejie; Wang, Jianchen; Xing, Yuan; Wang, Shuxin; Ren, Xiangyun

    2017-12-01

    Most of the existing robotic platforms for LESS have workspace and load capacity weaknesses, because of the limitation of one single incision. We have developed a LESS manual operating platform of which the stiffness of the insertion tube is controllable. The system included two dexterous tool manipulators, a stereo-vision module and a variable stiffness insertion tube (VSIT), which was designed using phase-change material (mixed indium, gallium and stannum). Experiments to evaluate the effectiveness of the VSIT were set up. Peg transfer tasks and trajectory tracking tasks were conducted to assess the initial performance of the overall system. The experimental results for stiffness characteristic suggested that the rigidity of the VSIT with a straight-forward pose was considerably increased by about four times in the rigid mode. Peg transfer tasks and trajectory tracking tasks were performed successfully with an average time of 97 s and 52 s, respectively. The experimental results for stiffness characteristic showed that the manual operating platform had great promise for solving large workspace, high manipulation force and stability problems in LESS. The tool manipulators had the ability to achieve basic operations. Copyright © 2017 John Wiley & Sons, Ltd.

  14. Collaborating to increase access to clinical and educational resources for surgery: a case study.

    Science.gov (United States)

    Tomasko, Jonathan M; Adams, Nancy E; Garritano, Frank G; Santos, Mary C; Dillon, Peter W

    2014-01-01

    A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

    Science.gov (United States)

    Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

    2017-01-01

    To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  16. Laparo-endoscopic single-site (LESS) cholecystectomy with epidural vs. general anesthesia.

    Science.gov (United States)

    Ross, Sharona B; Mangar, Devanand; Karlnoski, Rachel; Camporesi, Enrico; Downes, Katheryne; Luberice, Kenneth; Haines, Krista; Rosemurgy, Alexander S

    2013-05-01

    Laparo-endoscopic single-site (LESS) surgery involves a single umbilical incision, lending itself to epidural anesthesia. This prospective, randomized study was undertaken to evaluate epidural anesthesia for patients undergoing LESS cholecystectomy, to assess the feasibility, and to analyze all intraoperative and postoperative complications. The secondary objectives were to determine differences in postoperative pain and time until PACU discharge-to-home readiness between patients. With institutional review board approval, 20 patients with chronic cholecystitis, cholelithiasis, and/or biliary dyskinesia were randomized to receive spinal epidural anesthesia (n = 10) or general anesthesia (n = 10). Postoperative pain at rest was recorded in the PACU every 10 min, and at rest and walking at discharge using the visual analog scale (VAS). Operative time and time until PACU discharge-to-home readiness were recorded. Results are expressed as mean ± SD. Patient age, American Society of Anesthesiologists class, and body mass index were similar. There were no additional ports/incisions, conversions to "open" operations, or conversions to general anesthesia. There were no differences in operative duration. Time until postanesthesia care unit discharge-to-home ready was not significantly different. The most common postoperative adverse event was urinary retention (1 epidural and 3 general anesthesia patients). Resting postoperative VAS pain score at discharge was 4.7 ± 2.5 vs. 2.2 ± 1.6 (p = 0.02, general versus epidural anesthesia respectively); the stressed VAS pain score at discharge was 6.1 ± 2.3 vs. 3.1 ± 2.8 (p = 0.02, general versus epidural anesthesia respectively). LESS cholecystectomy with epidural anesthesia was completed with no operative or anesthetic conversions, and less postoperative pain at discharge. Epidural anesthesia appears to be a preferable alternative to general anesthesia for patients undergoing LESS cholecystectomy.

  17. Single port laparoscopic surgery

    DEFF Research Database (Denmark)

    Springborg, Henrik; Istre, Olav

    2012-01-01

    potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions......LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...

  18. Surgery

    Science.gov (United States)

    ... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...

  19. Influence of a rural environment on patient access and outcomes for bariatric surgery.

    Science.gov (United States)

    Bergmann, Kristie L; Cox, Stephanie J; Tabone, Lawrence E

    2017-04-01

    Despite a higher rate of obesity in rural populations, there is a 23% decrease in performed bariatric procedures. The influence of a rural environment on surgical outcomes and treatment efficacy is unknown. We retrospectively reviewed all bariatric surgeries performed in a large university hospital in West Virginia from September 2012 to September 2014. Patients were categorized based on their rural-urban commuting area codes. Subject demographic characteristics, insurance provider, type of surgery, completion of program, preoperative body mass index (BMI), percent excess weight loss (%EWL), and percent total weight loss (%TWL) at 6 and 12 months postoperatively, and follow-up appointment attendance were collected. Logistic and linear regression analyses were conducted. A total of 122 patients were evaluated with 82 receiving surgery. Of these patients, 77 had Roux-en-Y gastric bypass, and 5 had Sleeve Gastrectomy. Nine patients out of 82 were lost to follow-up at 6 months (n = 73), and 12 patients out of 62 were lost to follow-up at 12 months (n = 50). Rural patients were .283 times less likely to receive bariatric surgery, (P = .004). However, this relationship was confounded by insurance provider; after controlling for this variable, the relationship between rural status and surgery completion was nonsignificant (P = .066). Rural status did not predict change in BMI, %EWL, or %TWL at 6 months (P = .738; P = .848; P = .334) or 12 months (P = .902; P = .143; P = .195), or compliance for follow-up appointments (P = .232). Rural bariatric patients seem to have decreased success at completing bariatric programs, which is likely confounded by insurance type. Yet, when the rural patient is able to realize the benefits of bariatric surgery, their outcomes are unchanged compared with urban patients. Although the study is limited by sample size, it highlights the need for reducing obstacles for bariatric surgery in an already underserved population, the rural community

  20. Robot-assisted surgery for kidney cancer increased access to a procedure that can reduce mortality and renal failure.

    Science.gov (United States)

    Chandra, Amitabh; Snider, Julia Thornton; Wu, Yanyu; Jena, Anupam; Goldman, Dana P

    2015-02-01

    Surgeons increasingly use robot-assisted minimally invasive surgery for a variety of medical conditions. For hospitals, the acquisition and maintenance of a robot requires a significant investment, but financial returns are not linked to any improvement in long-term patient outcomes in the current reimbursement environment. Kidney cancer provides a useful case study for evaluating the long-term value that this innovation can provide. Kidney cancer is generally treated through partial or radical nephrectomy, with evidence favoring the former procedure for appropriate patients. We found that robot-assisted surgery increased access to partial nephrectomy and that partial nephrectomy reduced mortality and renal failure. The value of the benefits of robot-assisted minimally invasive surgery to patients, in terms of quality-adjusted life-years gained, outweighed the health care and surgical costs to patients and payers by a ratio of five to one. In addition, we found no evidence that the availability of robot-assisted minimally invasive surgery increased the likelihood that inappropriate patients received partial nephrectomy. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Laparoscopic colonic resection in inflammatory bowel disease: minimal surgery, minimal access and minimal hospital stay.

    LENUS (Irish Health Repository)

    Boyle, E

    2008-11-01

    Laparoscopic surgery for inflammatory bowel disease (IBD) is technically demanding but can offer improved short-term outcomes. The introduction of minimally invasive surgery (MIS) as the default operative approach for IBD, however, may have inherent learning curve-associated disadvantages. We hypothesise that the establishment of MIS as the standard operative approach does not increase patient morbidity as assessed in the initial period of its introduction into a specialised unit, and that it confers earlier postoperative gastrointestinal recovery and reduced hospitalisation compared with conventional open resection.

  2. Surgery

    Science.gov (United States)

    ... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...

  3. Surgery Hours for All: An Adoption of Live Classroom Technology for Enhanced Accessibility

    OpenAIRE

    Osama Khan

    2010-01-01

    Adobe Connect Pro was used as a virtual learning platform to replace surgery hours in a module titled Real Estate Finance and Investment. This research explores different aspects of this technology, how it was implemented in the above mentioned module, and the critical feedback we received from the students. The paper also analyses its potential in different academic context and to facilitate blended learning.

  4. Minimal access surgery in children: An initial experience of 28 months

    African Journals Online (AJOL)

    One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very ...

  5. The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act.

    Science.gov (United States)

    Wiznia, Daniel H; Nwachuku, Emmanuel; Roth, Alexander; Kim, Chang-Yeon; Save, Ameya; Anandasivam, Nidharshan S; Medvecky, Michael; Pelker, Richard

    2017-07-01

    The goal of the Patient Protection and Affordable Care Act (PPACA) was to expand patient access to health care. Since the rollout of the PPACA, Medicaid patients have demonstrated difficulty obtaining appointments in some specialty care settings. To assess the effect of insurance type (Medicaid and private) on patient access to orthopaedic surgery sports medicine specialists for a semiurgent evaluation of a likely operative bucket-handle meniscus tear. The study was designed to determine whether disparities in access exist since the PPACA rollout. Cohort study; Level of evidence, 2. The design was to call 180 orthopaedic surgery sports medicine specialists in 6 representative states (California, Ohio, New York, Florida, Texas, and North Carolina) between June 2015 and December 2015. An appointment was requested for the caller's fictitious 25-year-old-brother who had suffered a bucket-handle meniscus tear. Each office was called twice to assess the ease of obtaining an appointment: once for patients with Medicaid and once for patients with private insurance. For each call, data pertaining to whether an appointment was given, wait times, and barriers to receiving an appointment were recorded. A total of 177 surgeons were called within the study period. Overall, 27.1% of offices scheduled an appointment for a patient with Medicaid, compared with 91.2% ( P insurance. Medicaid patients were significantly more likely to be denied an appointment due to lack of referral compared with private patients (40.2% vs 3.7%, P medicine specialists between Medicaid-expanded and -nonexpanded states. Medicaid reimbursement for knee arthroscopy with meniscus repair was not significantly correlated with appointment success rate or patient waiting periods. Despite the passage of the PPACA, patients with Medicaid have reduced access to care. In addition, patients with Medicaid confront more barriers to receiving appointments than patients with private insurance and wait longer for an

  6. Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

    Directory of Open Access Journals (Sweden)

    Ricardo Landini Lutaif Dolci

    Full Text Available Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity and the subarachnoid space (sterile area, reducing the high risk of contamination. Objective: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy, internal nasal valve failure, epistaxis, and olfactory alterations. Results: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension, three had meningiomas (two tuberculum sellae and one olfactory groove, two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%, meningitis (three patients; 7.3%, nasal fossa synechia (eight patients; 19.5%, internal nasal valve failure (six patients; 14.6%, and complaints of worsening of the sense of smell (16 patients; 39%. The olfactory test showed anosmia or hyposmia in ten patients (24.3%. No patient had mucocele, epistaxis, or septal perforation. Conclusion: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted

  7. Single-Site Palladium(II) Catalyst for Oxidative Heck Reaction: Catalytic Performance and Kinetic Investigations

    Energy Technology Data Exchange (ETDEWEB)

    Duan, Hui; Li, Mengyang; Zhang, Guanghui; Gallagher, James R.; Huang, Zhiliang; Sun, Yu; Luo, Zhong; Chen, Hongzhong; Miller, Jeffrey T.; Zou, Ruqiang; Lei, Aiwen; Zhao, Yanli

    2015-01-01

    ABSTRACT: The development of organometallic single-site catalysts (SSCs) has inspired the designs of new heterogeneous catalysts with high efficiency. Nevertheless, the application of SSCs in certain modern organic reactions, such as C-C bond formation reactions, has still been less investigated. In this study, a single-site Pd(II) catalyst was developed, where 2,2'-bipyridine-grafted periodic mesoporous organosilica (PMO) was employed as the support of a Pd(II) complex. The overall performance of the single-site Pd(II) catalyst in the oxidative Heck reaction was then investigated. The investigation results show that the catalyst displays over 99% selectivity for the product formation with high reaction yield. Kinetic profiles further confirm its high catalytic efficiency, showing that the rate constant is nearly 40 times higher than that for the free Pd(II) salt. X-ray absorption spectroscopy reveals that the catalyst has remarkable lifetime and recyclability.

  8. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2018-03-01

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  9. Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia.

    Science.gov (United States)

    Dennis, Alicia T

    2018-01-01

    Papua New Guinea has one of the world's highest maternal mortality rates with approximately 215 women dying per 100,000 live births. The sustainable development goals outline key priority areas for achieving a reduction in maternal mortality including a focus on universal health coverage with safe surgery and anesthesia for all pregnant women. This narrative review addresses the issue of reducing maternal mortality in Papua New Guinea by contextualizing the need for safe obstetric surgery and anesthesia within a structure of enabling environments at key times in a woman's life. The 3 pillars of enabling environments are as follows: a stable humanitarian government; a safe, secure, and clean environment; and a strong health system. Key times, and their associated specific issues, in a woman's life include prepregnancy, antenatal, birth and the postpartum period, childhood, adolescence and young womanhood, and the postchildbearing years.

  10. Patient access in plastic surgery: an operational and financial analysis of service-based interventions to improve ambulatory throughput in an academic surgery practice.

    Science.gov (United States)

    Hultman, Charles Scott; Gilland, Wendell G; Weir, Samuel

    2015-06-01

    Inefficient patient throughput in a surgery practice can result in extended new patient backlogs, excessively long cycle times in the outpatient clinics, poor patient satisfaction, decreased physician productivity, and loss of potential revenue. This project assesses the efficacy of multiple throughput interventions in an academic, plastic surgery practice at a public university. We implemented a Patient Access and Efficiency (PAcE) initiative, funded and sponsored by our health care system, to improve patient throughput in the outpatient surgery clinic. Interventions included: (1) creation of a multidisciplinary team, led by a project redesign manager, that met weekly; (2) definition of goals, metrics, and target outcomes; 3) revision of clinic templates to reflect actual demand; 4) working down patient backlog through group visits; 5) booking new patients across entire practice; 6) assigning a physician's assistant to the preoperative clinic; and 7) designating a central scheduler to coordinate flow of information. Main outcome measures included: patient satisfaction using Press-Ganey surveys; complaints reported to patient relations; time to third available appointment; size of patient backlog; monthly clinic volumes with utilization rates and supply/demand curves; "chaos" rate (cancellations plus reschedules, divided by supply, within 48 hours of booked clinic date); patient cycle times with bottleneck analysis; physician productivity measured by work Relative Value Units (wRVUs); and downstream financial effects on billing, collection, accounts receivable (A/R), and payer mix. We collected, managed, and analyzed the data prospectively, comparing the pre-PAcE period (6 months) with the PAcE period (6 months). The PAcE initiative resulted in multiple improvements across the entire plastic surgery practice. Patient satisfaction increased only slightly from 88.5% to 90.0%, but the quarterly number of complaints notably declined from 17 to 9. Time to third

  11. Accessibility

    DEFF Research Database (Denmark)

    Brooks, Anthony Lewis

    2017-01-01

    This contribution is timely as it addresses accessibility in regards system hardware and software aligned with introduction of the Twenty-First Century Communications and Video Accessibility Act (CVAA) and adjoined game industry waiver that comes into force January 2017. This is an act created...... by the USA Federal Communications Commission (FCC) to increase the access of persons with disabilities to modern communications, and for other purposes. The act impacts advanced communications services and products including text messaging; e-mail; instant messaging; video communications; browsers; game...... platforms; and games software. However, the CVAA has no legal status in the EU. This text succinctly introduces and questions implications, impact, and wider adoption. By presenting the full CVAA and game industry waiver the text targets to motivate discussions and further publications on the subject...

  12. Team training to establish a safety culture in dialysis access surgery.

    Science.gov (United States)

    Davidson, Ingemar; Widmer, Matthias K; Nolen, Billy; Ross, John; Slakey, Douglas P

    2015-01-01

    Operating room (OR) team safety training and learning in the field of dialysis access is well suited for the use of simulators, simulated case learning and root cause analysis of adverse outcomes. The objectives of OR team training are to improve communication and leadership skills, to use checklists and to prevent errors. Other objectives are to promote a change in the attitudes towards vascular access from learning through mistakes in a nonpunitive environment, to positively impact the employee performance and to increase staff retention by making the workplace safer, more efficient and user friendly. © 2015 S. Karger AG, Basel

  13. The benefit of non contrast-enhanced magnetic resonance angiography for predicting vascular access surgery outcome: a computer model perspective.

    Science.gov (United States)

    Merkx, Maarten A G; Huberts, Wouter; Bosboom, E Mariëlle H; Bode, Aron S; Bescós, Javier Oliván; Tordoir, Jan H M; Breeuwer, Marcel; van de Vosse, Frans N

    2013-01-01

    Vascular access (VA) surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD) patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative flow enhancement was developed. The purpose of this study is to assess the benefit of non contrast-enhanced magnetic resonance angiography (NCE-MRA) data as patient-specific geometrical input for the model-based prediction of surgery outcome. 25 ESRD patients were included in this study. All patients received a NCE-MRA examination of the upper extremity blood vessels in addition to routine ultrasound (US). Local arterial radii were assessed from NCE-MRA and converted to model input using a linear fit per artery. Venous radii were determined with US. The effect of radius measurement uncertainty on model predictions was accounted for by performing Monte-Carlo simulations. The resulting flow prediction interval of the computer model was compared with the postoperative flow obtained from US. Patients with no overlap between model-based prediction and postoperative measurement were further analyzed to determine whether an increase in geometrical detail improved computer model prediction. Overlap between postoperative flows and model-based predictions was obtained for 71% of patients. Detailed inspection of non-overlapping cases revealed that the geometrical details that could be assessed from NCE-MRA explained most of the differences, and moreover, upon addition of these details in the computer model the flow predictions improved. The results demonstrate clearly that NCE-MRA does provide valuable geometrical information for VA surgery planning. Therefore, it is recommended to use this modality, at least for patients at risk for local or global narrowing of the blood vessels as well as for patients for whom an US-based model prediction would not overlap with surgical choice, as the

  14. The benefit of non contrast-enhanced magnetic resonance angiography for predicting vascular access surgery outcome: a computer model perspective.

    Directory of Open Access Journals (Sweden)

    Maarten A G Merkx

    Full Text Available INTRODUCTION: Vascular access (VA surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative flow enhancement was developed. The purpose of this study is to assess the benefit of non contrast-enhanced magnetic resonance angiography (NCE-MRA data as patient-specific geometrical input for the model-based prediction of surgery outcome. METHODS: 25 ESRD patients were included in this study. All patients received a NCE-MRA examination of the upper extremity blood vessels in addition to routine ultrasound (US. Local arterial radii were assessed from NCE-MRA and converted to model input using a linear fit per artery. Venous radii were determined with US. The effect of radius measurement uncertainty on model predictions was accounted for by performing Monte-Carlo simulations. The resulting flow prediction interval of the computer model was compared with the postoperative flow obtained from US. Patients with no overlap between model-based prediction and postoperative measurement were further analyzed to determine whether an increase in geometrical detail improved computer model prediction. RESULTS: Overlap between postoperative flows and model-based predictions was obtained for 71% of patients. Detailed inspection of non-overlapping cases revealed that the geometrical details that could be assessed from NCE-MRA explained most of the differences, and moreover, upon addition of these details in the computer model the flow predictions improved. CONCLUSIONS: The results demonstrate clearly that NCE-MRA does provide valuable geometrical information for VA surgery planning. Therefore, it is recommended to use this modality, at least for patients at risk for local or global narrowing of the blood vessels as well as for patients for whom an US-based model

  15. Who accesses surgery at district level in sub-Saharan Africa? Evidence from Malawi and Zambia.

    Science.gov (United States)

    Gajewski, Jakub; Dharamshi, Rachel; Strader, Michael; Kachimba, John; Borgstein, Eric; Mwapasa, Gerald; Cheelo, Mweene; McCauley, Tracey; Bijlmakers, Leon; Brugha, Ruairi

    2017-12-01

    To examine age and gender distribution for the most common types of surgery in Malawi and Zambia. Data were collected from major operating theatres in eight district hospitals in Malawi and nine in Zambia. Raw data on surgical procedures were coded by specialist surgeons for frequency analyses. In Malawi female surgical patients had a mean age of 25 years, with 91% aged 16-40 years. Females accounted for 85%, and obstetric cases for 75%, of all surgical patients. In Zambia, female surgical patients had a mean age of 26, with 75% aged 16-40 years. They accounted for 55% of all cases, 34% being obstetric. Male surgical patients in Malawi were on average older (33 years) than in Zambia (23 years). General surgical cases in men and women, respectively, had a median age of 42 and 32 in Malawi and 26 and 30 in Zambia. The median age of trauma patients was 12 in males and 10 in females in both countries. Children aged 0-15 years accounted for 64-65% of all trauma cases in Malawi and 57-58% in Zambia, with peak incidences in 6- to 10-year-olds. Women of reproductive (16-45 years) mainly undergoing Caesarean sections and children aged 0-15 years who accounted for two-thirds of trauma cases are the main patient populations undergoing surgery at district hospitals in Zambia and Malawi. Verification and analysis of routine hospital data, across 10-30% of districts countrywide, demonstrated the need to prioritise quality assurance in surgery and anaesthesia, and preventive interventions in children. © 2017 John Wiley & Sons Ltd.

  16. Benefits of Minimal Access Surgery in Elderly Patients with Pelvic Cancer

    Directory of Open Access Journals (Sweden)

    Vincent Lavoué

    2016-01-01

    Full Text Available An increasing proportion of patients requiring treatment for malignancy are elderly, which has created new challenges for oncologic surgeons. Aging is associated with an increasing prevalence of frailty and comorbidities that may affect the outcome of surgical procedures. By decreasing complications and shortening length of hospital stay without affecting oncologic safety, surgery performed using the robot, rather than traditional laparotomy, improves the chances of a better outcome in our growing elderly populations. In addition to age, surgeons should take into account factors, such as frailty and comorbidities that correlate with outcome.

  17. Metal–organic and covalent organic frameworks as single-site catalysts

    Science.gov (United States)

    Rogge, S. M. J.; Bavykina, A.; Hajek, J.; Garcia, H.; Olivos-Suarez, A. I.; Sepúlveda-Escribano, A.; Vimont, A.; Clet, G.; Bazin, P.; Kapteijn, F.

    2017-01-01

    Heterogeneous single-site catalysts consist of isolated, well-defined, active sites that are spatially separated in a given solid and, ideally, structurally identical. In this review, the potential of metal–organic frameworks (MOFs) and covalent organic frameworks (COFs) as platforms for the development of heterogeneous single-site catalysts is reviewed thoroughly. In the first part of this article, synthetic strategies and progress in the implementation of such sites in these two classes of materials are discussed. Because these solids are excellent playgrounds to allow a better understanding of catalytic functions, we highlight the most important recent advances in the modelling and spectroscopic characterization of single-site catalysts based on these materials. Finally, we discuss the potential of MOFs as materials in which several single-site catalytic functions can be combined within one framework along with their potential as powerful enzyme-mimicking materials. The review is wrapped up with our personal vision on future research directions. PMID:28338128

  18. Understanding the role of aluminum-based activators in single site iron catalysts for ethylene oligomerization.

    OpenAIRE

    Boudene , Zoubeyr; Boudier , Adrien; Breuil , Pierre-Alain; Olivier-Bourbigou , Hélène; Raybaud , Pascal; Toulhoat , Hervé; De Bruin , Theodorus

    2014-01-01

    International audience; In a combined experimental and theoretical study, the activation process of a single site ethylene oligomerization catalyst with aluminum-based activators has been studied. The results put forward a plausible deactivation reaction path of the catalyst for trimethylaluminum, while for methylaluminoxane and a novel phenoxyaluminum-based activator, the experimental catalyst's activity correlates with the energy barrier for the ethylene insertion.

  19. Disparity in access and outcomes for emergency neonatal surgery: intestinal atresia in Kampala, Uganda.

    Science.gov (United States)

    Cairo, Sarah; Kakembo, Nasser; Kisa, Phyllis; Muzira, Arlene; Cheung, Maija; Healy, James; Ozgediz, Doruk; Sekabira, John

    2017-08-01

    Intestinal atresia is one of the leading causes of neonatal intestinal obstruction (NIO). The purpose of this study was to analyze the presentation and outcome of IA and compare with those from both similar and high-income country settings. A retrospective review of prospectively collected data from patient charts and pediatric surgical database for 2012-2015 was performed. Epidemiological data and patient characteristics were analyzed and outcomes were compared with those reported in other LMICs and high-income countries (HICs). Unmet need was calculated along with economic valuation or economic burden of surgical disease. Of 98 patients, 42.9% were male. 35 patients had duodenal atresia (DA), 60 had jejunio-ileal atresia (JIA), and 3 had colonic atresia. The mean age at presentation was 7.14 days for DA and 6.7 days for JIA. Average weight for DA and JIA was 2.2 and 2.12 kg, respectively. All patients with DA and colonic atresia underwent surgery, and 88.3% of patients with JIA had surgery. Overall mortality was 43% with the majority of deaths attributable to aspiration, anastomotic leak, and sepsis. 3304 DALYs were calculated as met compared to 25,577 DALYs' unmet. Patients with IA in Uganda present late in the clinical course with high morbidity and mortality attributable to a combination of late presentation, poor nutrition status, surgical complications, and likely underreporting of associated anomalies rather than surgical morbidity alone. Level IV, Case series with no comparison group.

  20. Electricity and generator availability in LMIC hospitals: improving access to safe surgery.

    Science.gov (United States)

    Chawla, Sagar; Kurani, Shaheen; Wren, Sherry M; Stewart, Barclay; Burnham, Gilbert; Kushner, Adam; McIntyre, Thomas

    2018-03-01

    Access to reliable energy has been identified as a global priority and codified within United Nations Sustainable Goal 7 and the Electrify Africa Act of 2015. Reliable hospital access to electricity is necessary to provide safe surgical care. The current state of electrical availability in hospitals in low- and middle-income countries (LMICs) throughout the world is not well known. This study aimed to review the surgical capacity literature and document the availability of electricity and generators. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search for surgical capacity assessments in LMICs in MEDLINE, PubMed, and World Health Organization Global Health Library was performed. Data regarding electricity and generator availability were extracted. Estimated percentages for individual countries were calculated. Of 76 articles identified, 21 reported electricity availability, totaling 528 hospitals. Continuous electricity availability at hospitals providing surgical care was 312/528 (59.1%). Generator availability was 309/427 (72.4%). Estimated continuous electricity availability ranged from 0% (Sierra Leone and Malawi) to 100% (Iran); estimated generator availability was 14% (Somalia) to 97.6% (Iran). Less than two-thirds of hospitals providing surgical care in 21 LMICs have a continuous electricity source or have an available generator. Efforts are needed to improve electricity infrastructure at hospitals to assure safe surgical care. Future research should look at the effect of energy availability on surgical care and patient outcomes and novel methods of powering surgical equipment. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. The foramen and infraorbital nerve relating to the surgery for external access to the maxillary sinus (CALDWELL-LUC

    Directory of Open Access Journals (Sweden)

    Fabi, Ricardo Pereira

    2008-09-01

    Full Text Available Introduction: The infraorbital nerve and foramen are bilateral structures, located below the lower edge of orbit (1,2,5,9,10,11,12, and are important surgical parameters for external access to the maxillary sinus (CaldwellLuc, representing its upper limit (4, 13. Objective: Establishing a safe average distance between the first premolar tooth alveolus top up to the foramen and infraorbital nerve, during the CaldwellLuc surgery. Method: We have analyzed 32 formolized heads of Brazilian adult corpses, without distinction of age, sex and race, within the period of February through July 2004. Surgical approach was made by CaldwellLuc passage, up to the complete exposure of infraorbital nerve and foramen where we delineated an imaginary line from the top of the first premolar tooth alveolus up to the foramen, and measured by using a pachymeter. Results: The general average distance between the structures mentioned was of 3.34cm with standard deviation of 0.52cm. The greater distance found was of 4,5 cm and the minor was of 2.5 cm bilaterally. Conclusion: When we know this region safe distance surgical access, we find less damage to the innervation that causes less intense subjective and less persistent symptoms in the post-operative period.

  2. Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico

    Directory of Open Access Journals (Sweden)

    Skipper Betty

    2006-06-01

    Full Text Available Abstract Background A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures. Methods Chi-square tests determined if there was a statistically significant difference between the number of self-pay and insured patient cancellations for financial reasons. A multivariate binomial regression model was used to calculate risk ratios and confidence limits for effects of race/ethnicity, and insurance status, controlling for gender, on these cancellations. Results Of the 667 cancellations, there were 99 self-pay and 568 insured patients. Cancellations for financial reasons occurred in 55.6% of self-pay and 9.3% of insured patients (p Conclusion Self-pay patients, regardless of race/ethnicity, have elective surgical procedures cancelled for financial reasons significantly more often than insured patients. The hospital's 50% up-front payment policy represents a significant financial barrier to accessing elective surgical procedures for self-pay patients.

  3. Improving access to bariatric surgery: early surgical and patient-focused outcomes of a rural obesity clinic.

    Science.gov (United States)

    Chan, Angela W; Hopkins, Julie; Gagnon, Isabelle; Birch, Daniel W

    2016-05-01

    Bariatric surgery is typically offered in larger health care centers, forcing patients to travel long distances to access care. An adult obesity program was established in Whitehorse, Yukon based on the multidisciplinary adult bariatric clinic in Edmonton, to alleviate long-distance care difficulties. This study analyzes patient/health care staff satisfaction and surgical outcomes for this program. A survey was administered to patients and health care staff at Edmonton and Whitehorse. Patient charts were reviewed. A multivariate linear regression predicted the main effect of travel distance and other clinical covariates on follow-up compliance. Postoperative body mass index, complications, and satisfaction scores were similar. Whitehorse patients had higher rates of follow-up (85.6% vs 71.1%, P = .002). The Whitehorse Bariatric Program provides perioperative obesity care comparable to a larger center. Patient follow-up and satisfaction suggest a highly successful program. This may serve as a model for improving access to obesity services across Canada. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Single-site catalyst promoters accelerate metal-catalyzed nitroarene hydrogenation

    KAUST Repository

    Wang, Liang

    2018-04-04

    Atomically dispersed supported metal catalysts are drawing wide attention because of the opportunities they offer for new catalytic properties combined with efficient use of the metals. We extend this class of materials to catalysts that incorporate atomically dispersed metal atoms as promoters. The catalysts are used for the challenging nitroarene hydrogenation and found to have both high activity and selectivity. The promoters are single-site Sn on TiO2 supports that incorporate metal nanoparticle catalysts. Represented as M/Sn-TiO2 (M = Au, Ru, Pt, Ni), these catalysts decidedly outperform the unpromoted supported metals, even for hydrogenation of nitroarenes substituted with various reducible groups. The high activity and selectivity of these catalysts result from the creation of oxygen vacancies on the TiO2 surface by single-site Sn, which leads to efficient, selective activation of the nitro group coupled with a reaction involving hydrogen atoms activated on metal nanoparticles.

  5. Development of a functional, internet-accessible department of surgery outcomes database.

    Science.gov (United States)

    Newcomb, William L; Lincourt, Amy E; Gersin, Keith; Kercher, Kent; Iannitti, David; Kuwada, Tim; Lyons, Cynthia; Sing, Ronald F; Hadzikadic, Mirsad; Heniford, B Todd; Rucho, Susan

    2008-06-01

    The need for surgical outcomes data is increasing due to pressure from insurance companies, patients, and the need for surgeons to keep their own "report card". Current data management systems are limited by inability to stratify outcomes based on patients, surgeons, and differences in surgical technique. Surgeons along with research and informatics personnel from an academic, hospital-based Department of Surgery and a state university's Department of Information Technology formed a partnership to develop a dynamic, internet-based, clinical data warehouse. A five-component model was used: data dictionary development, web application creation, participating center education and management, statistics applications, and data interpretation. A data dictionary was developed from a list of data elements to address needs of research, quality assurance, industry, and centers of excellence. A user-friendly web interface was developed with menu-driven check boxes, multiple electronic data entry points, direct downloads from hospital billing information, and web-based patient portals. Data were collected on a Health Insurance Portability and Accountability Act-compliant server with a secure firewall. Protected health information was de-identified. Data management strategies included automated auditing, on-site training, a trouble-shooting hotline, and Institutional Review Board oversight. Real-time, daily, monthly, and quarterly data reports were generated. Fifty-eight publications and 109 abstracts have been generated from the database during its development and implementation. Seven national academic departments now use the database to track patient outcomes. The development of a robust surgical outcomes database requires a combination of clinical, informatics, and research expertise. Benefits of surgeon involvement in outcomes research include: tracking individual performance, patient safety, surgical research, legal defense, and the ability to provide accurate information

  6. Theoretical study of catalytic mechanism for single-site water oxidation process.

    Science.gov (United States)

    Lin, Xiangsong; Hu, Xiangqian; Concepcion, Javier J; Chen, Zuofeng; Liu, Shubin; Meyer, Thomas J; Yang, Weitao

    2012-09-25

    Water oxidation is a linchpin in solar fuels formation, and catalysis by single-site ruthenium complexes has generated significant interest in this area. Combining several theoretical tools, we have studied the entire catalytic cycle of water oxidation for a single-site catalyst starting with [Ru(II)(tpy)(bpm)(OH(2))](2+) (i.e., [Ru(II)-OH(2)](2+); tpy is 2,2':6',2''-terpyridine and bpm is 2,2'-bypyrimidine) as a representative example of a new class of single-site catalysts. The redox potentials and pK(a) calculations for the first two proton-coupled electron transfers (PCETs) from [Ru(II)-OH(2)](2+) to [Ru(IV) = O](2+) and the following electron-transfer process to [Ru(V) = O](3+) suggest that these processes can proceed readily in acidic or weakly basic conditions. The subsequent water splitting process involves two water molecules, [Ru(V) = O](3+) to generate [Ru(III)-OOH](2+), and H(3)O(+) with a low activation barrier (~10 kcal/mol). After the key O-O bond forming step in the single-site Ru catalysis, another PECT process oxidizes [Ru(III)-OOH](2+) to [Ru(IV)-OO](2+) when the pH is lower than 3.7. Two possible forms of [Ru(IV)-OO](2+), open and closed, can exist and interconvert with a low activation barrier (catalytic cycle. This understanding is helpful in the design of new catalysts for water oxidation.

  7. Well-defined single-site monohydride silica-supported zirconium from azazirconacyclopropane

    KAUST Repository

    Hamzaoui, Bilel

    2015-01-13

    The silica-supported azazirconacyclopropane ≡SiOZr(HNMe2)(η2-NMeCH2)(NMe2) (1) leads exclusively under hydrogenolysis conditions (H2, 150°C) to the single-site monopodal monohydride silica-supported zirconium species ≡SiOZr(HNMe2)(NMe2)2H (2). Reactivity studies by contacting compound 2 with ethylene, hydrogen/ethylene, propene, or hydrogen/propene, at a temperature of 200°C revealed alkene hydrogenation.

  8. Ligand-tailored single-site silica supported titanium catalysts: Synthesis, characterization and towards cyanosilylation reaction

    International Nuclear Information System (INIS)

    Xu, Wei; Li, Yani; Yu, Bo; Yang, Jindou; Zhang, Ying; Chen, Xi; Zhang, Guofang; Gao, Ziwei

    2015-01-01

    A successive anchoring of Ti(NMe 2 ) 4 , cyclopentadiene and a O-donor ligand, 1-hydroxyethylbenzene (PEA), 1,1′-bi-2-naphthol (Binol) or 2,3-dihydroxybutanedioic acid diethyl ester (Tartrate), on silica was conducted by SOMC strategy in moderate conditions. The silica, monitored by in-situ Fourier transform infrared spectroscopy (in-situ FT-IR), was pretreated at different temperatures (200, 500 and 800 °C). The ligand tailored silica-supported titanium complexes were characterized by in-situ FT-IR, 13 C CP MAS-NMR, X-ray photoelectron spectroscopy (XPS), X-ray absorption near edge structure (XANES) and elemental analysis in detail, verifying that the surface titanium species are single sited. The catalytic activity of the ligand tailored single-site silica supported titanium complexes was evaluated by a cyanosilylation of benzaldehyde. The results showed that the catalytic activity is dependent strongly on the dehydroxylation temperatures of silica and the configuration of the ligands. - Graphical abstract: The ligand-tailored silica supported “single site” titanium complexes were synthesized by SOMC strategy and fully characterized. Their catalytic activity were evaluated by benzaldehyde silylcyanation. - Highlights: • Single-site silica supported Ti active species was prepared by SOMC technique. • O-donor ligand tailored Ti surface species was synthesized. • The surface species was characterized by XPS, 13 C CP-MAS NMR, XANES etc. • Catalytic activity of the Ti active species in silylcyanation reaction was evaluated

  9. Housing retention in single-site housing first for chronically homeless individuals with severe alcohol problems.

    Science.gov (United States)

    Collins, Susan E; Malone, Daniel K; Clifasefi, Seema L

    2013-12-01

    We studied housing retention and its predictors in the single-site Housing First model. Participants (n = 111) were chronically homeless people with severe alcohol problems who lived in a single-site Housing First program and participated in a larger nonrandomized controlled trial (2005-2008) conducted in Seattle, Washington. At baseline, participants responded to self-report questionnaires assessing demographic, illness burden, alcohol and other drug use, and psychiatric variables. Housing status was recorded over 2 years. Participants were interested in housing, although a sizable minority did not believe they would be able to maintain abstinence-based housing. Only 23% of participants returned to homelessness during the 2-year follow-up. Commonly cited risk factors--alcohol and other drug use, illness burden, psychiatric symptoms, and homelessness history--did not predict resumed homelessness. Active drinkers were more likely to stay in this housing project than nondrinkers. We found that single-site Housing First programming fills a gap in housing options for chronically homeless people with severe alcohol problems.

  10. Housing Retention in Single-Site Housing First for Chronically Homeless Individuals With Severe Alcohol Problems

    Science.gov (United States)

    Malone, Daniel K.; Clifasefi, Seema L.

    2013-01-01

    Objectives. We studied housing retention and its predictors in the single-site Housing First model. Methods. Participants (n = 111) were chronically homeless people with severe alcohol problems who lived in a single-site Housing First program and participated in a larger nonrandomized controlled trial (2005–2008) conducted in Seattle, Washington. At baseline, participants responded to self-report questionnaires assessing demographic, illness burden, alcohol and other drug use, and psychiatric variables. Housing status was recorded over 2 years. Results. Participants were interested in housing, although a sizable minority did not believe they would be able to maintain abstinence-based housing. Only 23% of participants returned to homelessness during the 2-year follow-up. Commonly cited risk factors—alcohol and other drug use, illness burden, psychiatric symptoms, and homelessness history—did not predict resumed homelessness. Active drinkers were more likely to stay in this housing project than nondrinkers. Conclusions. We found that single-site Housing First programming fills a gap in housing options for chronically homeless people with severe alcohol problems. PMID:24148063

  11. Torsion of a Subserosal Myoma Managed by Gasless Laparoendoscopic Single-Site Myomectomy with In-Bag Manual Extraction

    Directory of Open Access Journals (Sweden)

    Akihiro Takeda

    2016-01-01

    Full Text Available Acute torsion of a subserosal myoma is a rare surgical emergency that is infrequently diagnosed preoperatively. Furthermore, laparoendoscopic single-site (LESS myomectomy with in-bag tissue extraction for the management of this disorder has not yet been described. A 43-year-old, gravida 1, para 1 woman was referred to our department due to a solid pelvic mass associated with persistent abdominal pain. A pedunculated subserosal myoma with torsion was strongly suspected based on ultrasonography and magnetic resonance imaging. Emergency LESS surgery showed that the subserosal myoma arising from the posterior uterine wall torted at its pedicle in the cul-de-sac. The twisted myoma node was excised by coagulation and cut using a LigaSure Atlas, followed by in-bag manual morcellation and extraction through an umbilical wound. The present case report emphasizes that LESS myomectomy with in-bag tissue extraction is a feasible minimally invasive surgical option for the management of subserosal myoma with torsion after a precise imaging-based diagnostic evaluation.

  12. Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience.

    Science.gov (United States)

    Spinoglio, Giuseppe; Lenti, Luca Matteo; Maglione, Valeria; Lucido, Francesco Saverio; Priora, Fabio; Bianchi, Paolo Pietro; Grosso, Federica; Quarati, Raul

    2012-06-01

    Single-incision laparoscopic surgery is an emerging procedure developed to decrease parietal trauma and improve cosmetic results. However, many technical constraints, such as lack of triangulation, instrument collisions, and cross-handing, hamper this approach. Using a robotic platform may overcome these problems and enable more precise surgical actions by increasing freedom of movement and by restoring intuitive instrument control. We retrospectively collected, under institutional review board approval, data on the first 25 patients who underwent single-site robotic cholecystectomies (SSRC) at our center. Patients enrolled in this study underwent SSRC for symptomatic biliary gallstones or polyposis. Exclusion criteria were: BMI > 33; acute cholecystitis; previous upper abdominal surgery; ASA > II; and age >80 and <18 years. All procedures were performed with the da Vinci Si Surgical System and a dedicated SSRC kit (Intuitive). After discharge, patients were followed for 2 months. These SSRC cases were compared to our first 25 single-incision laparoscopic cholecystectomies (SILC) and with the literature. There were no differences in patient characteristics between groups (gender, P = 0.4404; age, P = 0.7423; BMI, P = 0.5699), and there were no conversions or major complications in either cohort. Operative time was significantly longer for the SILC group compared with SSRC (83.2 vs. 62.7 min, P = 0.0006), and SSRC operative times did not change significantly along the series. The majority of patients in each group were discharged within 24 h, with an average length of hospital stay of 1.2 days for the SILC group and 1.1 days for the SSRC group (P = 0.2854). No wound complications (infection, incisional hernia) were observed in the SSRC group and in the SILC. Our preliminary experience shows that SSRC is safe, can easily be learned, and performed in a reproducible manner and is faster than SILC.

  13. Reactivity of a Carbon-Supported Single-Site Molybdenum Dioxo Catalyst for Biodiesel Synthesis

    Energy Technology Data Exchange (ETDEWEB)

    Mouat, Aidan R.; Lohr, Tracy L.; Wegener, Evan C.; Miller, Jeffrey T.; Delferro, Massimiliano; Stair, Peter C.; Marks, Tobin J.

    2016-08-23

    A single-site molybdenum dioxo catalyst, (Oc)2Mo(=O)2@C, was prepared via direct grafting of MoO2Cl2(dme) (dme = 1,2-dimethoxyethane) on high-surface- area activated carbon. The physicochemical and chemical properties of this catalyst were fully characterized by N2 physisorption, ICP-AES/OES, PXRD, STEM, XPS, XAS, temperature-programmed reduction with H2 (TPR-H2), and temperature-programmed NH3 desorption (TPD-NH3). The single-site nature of the Mo species is corroborated by XPS and TPR-H2 data, and it exhibits the lowest reported MoOx Tmax of reduction reported to date, suggesting a highly reactive MoVI center. (Oc)2Mo(=O)2@C catalyzes the transesterification of a variety of esters and triglycerides with ethanol, exhibiting high activity at moderate temperatures (60-90 °C) and with negligible deactivation. (Oc)2Mo(=O)2@C is resistant to water and can be recycled at least three times with no loss of activity. The transesterification reaction is determined experimentally to be first order in [ethanol] and first order in [Mo] with ΔH = 10.5(8) kcal mol-1 and ΔS = -32(2) eu. The low energy of activation is consistent with the moderate conditions needed to achieve rapid turnover. This highly active carbon-supported single-site molybdenum dioxo species is thus an efficient, robust, and lowcost catalyst with significant potential for transesterification processes.

  14. Ligand-tailored single-site silica supported titanium catalysts: Synthesis, characterization and towards cyanosilylation reaction

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Wei; Li, Yani; Yu, Bo; Yang, Jindou; Zhang, Ying; Chen, Xi; Zhang, Guofang, E-mail: gfzhang@snnu.edu.cn; Gao, Ziwei, E-mail: zwgao@snnu.edu.cn

    2015-01-15

    A successive anchoring of Ti(NMe{sub 2}){sub 4}, cyclopentadiene and a O-donor ligand, 1-hydroxyethylbenzene (PEA), 1,1′-bi-2-naphthol (Binol) or 2,3-dihydroxybutanedioic acid diethyl ester (Tartrate), on silica was conducted by SOMC strategy in moderate conditions. The silica, monitored by in-situ Fourier transform infrared spectroscopy (in-situ FT-IR), was pretreated at different temperatures (200, 500 and 800 °C). The ligand tailored silica-supported titanium complexes were characterized by in-situ FT-IR, {sup 13}C CP MAS-NMR, X-ray photoelectron spectroscopy (XPS), X-ray absorption near edge structure (XANES) and elemental analysis in detail, verifying that the surface titanium species are single sited. The catalytic activity of the ligand tailored single-site silica supported titanium complexes was evaluated by a cyanosilylation of benzaldehyde. The results showed that the catalytic activity is dependent strongly on the dehydroxylation temperatures of silica and the configuration of the ligands. - Graphical abstract: The ligand-tailored silica supported “single site” titanium complexes were synthesized by SOMC strategy and fully characterized. Their catalytic activity were evaluated by benzaldehyde silylcyanation. - Highlights: • Single-site silica supported Ti active species was prepared by SOMC technique. • O-donor ligand tailored Ti surface species was synthesized. • The surface species was characterized by XPS, {sup 13}C CP-MAS NMR, XANES etc. • Catalytic activity of the Ti active species in silylcyanation reaction was evaluated.

  15. On multi-site damage identification using single-site training data

    Science.gov (United States)

    Barthorpe, R. J.; Manson, G.; Worden, K.

    2017-11-01

    This paper proposes a methodology for developing multi-site damage location systems for engineering structures that can be trained using single-site damaged state data only. The methodology involves training a sequence of binary classifiers based upon single-site damage data and combining the developed classifiers into a robust multi-class damage locator. In this way, the multi-site damage identification problem may be decomposed into a sequence of binary decisions. In this paper Support Vector Classifiers are adopted as the means of making these binary decisions. The proposed methodology represents an advancement on the state of the art in the field of multi-site damage identification which require either: (1) full damaged state data from single- and multi-site damage cases or (2) the development of a physics-based model to make multi-site model predictions. The potential benefit of the proposed methodology is that a significantly reduced number of recorded damage states may be required in order to train a multi-site damage locator without recourse to physics-based model predictions. In this paper it is first demonstrated that Support Vector Classification represents an appropriate approach to the multi-site damage location problem, with methods for combining binary classifiers discussed. Next, the proposed methodology is demonstrated and evaluated through application to a real engineering structure - a Piper Tomahawk trainer aircraft wing - with its performance compared to classifiers trained using the full damaged-state dataset.

  16. Ligand-tailored single-site silica supported titanium catalysts: Synthesis, characterization and towards cyanosilylation reaction

    Science.gov (United States)

    Xu, Wei; Li, Yani; Yu, Bo; Yang, Jindou; Zhang, Ying; Chen, Xi; Zhang, Guofang; Gao, Ziwei

    2015-01-01

    A successive anchoring of Ti(NMe2)4, cyclopentadiene and a O-donor ligand, 1-hydroxyethylbenzene (PEA), 1,1‧-bi-2-naphthol (Binol) or 2,3-dihydroxybutanedioic acid diethyl ester (Tartrate), on silica was conducted by SOMC strategy in moderate conditions. The silica, monitored by in-situ Fourier transform infrared spectroscopy (in-situ FT-IR), was pretreated at different temperatures (200, 500 and 800 °C). The ligand tailored silica-supported titanium complexes were characterized by in-situ FT-IR, 13C CP MAS-NMR, X-ray photoelectron spectroscopy (XPS), X-ray absorption near edge structure (XANES) and elemental analysis in detail, verifying that the surface titanium species are single sited. The catalytic activity of the ligand tailored single-site silica supported titanium complexes was evaluated by a cyanosilylation of benzaldehyde. The results showed that the catalytic activity is dependent strongly on the dehydroxylation temperatures of silica and the configuration of the ligands.

  17. Sintering-resistant Single-Site Nickel Catalyst Supported by Metal-Organic Framework

    Energy Technology Data Exchange (ETDEWEB)

    Li, Zhanyong; Schweitzer, Neil; League, Aaron; Bernales Candia, Sandra Varinia; Peters, Aaron; Getsoian, Andrew G.; Wang, Timothy; Miller, Jeffrey T.; Vjunov, Aleksei; Fulton, John L.; Lercher, Johannes A.; Cramer, Christopher J.; Gagliardi, Laura; Hupp, Joseph; Farha, Omar

    2016-02-17

    Developing supported single-site catalysts is an important goal in heterogeneous catalysis, since the well-defined active sites afford opportunities for detailed mechanistic studies, thereby facilitating the design of improved catalysts. We present herein a method for installing Ni ions uniformly and precisely on the node of a Zr-based MOF, NU-1000, in high density and large quantity (denoted as Ni-AIM) using atomic layer deposition (ALD) in a metal–organic framework (MOF) (AIM). Ni-AIM is demonstrated to be an efficient gas-phase hydrogenation catalyst upon activation. The structure of the active sites in Ni-AIM is proposed, revealing its single-site nature. More importantly, due to the organic linker used to construct the MOF support, the Ni ions stay isolated throughout the hydrogenation catalysis, in accord with its long-term stability. A quantum chemical characterization of the catalyst and the catalytic process complements the experimental results. With validation of computational modeling protocols, we further targeted ethylene oligomerization catalysis by Ni-AIM guided by theoretical prediction. Given the generality of the AIM methodology, this emerging class of materials should prove ripe for the discovery of new catalysts for the transformation of volatile substrates.

  18. Sintering-Resistant Single-Site Nickel Catalyst Supported by Metal-Organic Framework.

    Science.gov (United States)

    Li, Zhanyong; Schweitzer, Neil M; League, Aaron B; Bernales, Varinia; Peters, Aaron W; Getsoian, Andrew Bean; Wang, Timothy C; Miller, Jeffrey T; Vjunov, Aleksei; Fulton, John L; Lercher, Johannes A; Cramer, Christopher J; Gagliardi, Laura; Hupp, Joseph T; Farha, Omar K

    2016-02-17

    Developing supported single-site catalysts is an important goal in heterogeneous catalysis since the well-defined active sites afford opportunities for detailed mechanistic studies, thereby facilitating the design of improved catalysts. We present herein a method for installing Ni ions uniformly and precisely on the node of a Zr-based metal-organic framework (MOF), NU-1000, in high density and large quantity (denoted as Ni-AIM) using atomic layer deposition (ALD) in a MOF (AIM). Ni-AIM is demonstrated to be an efficient gas-phase hydrogenation catalyst upon activation. The structure of the active sites in Ni-AIM is proposed, revealing its single-site nature. More importantly, due to the organic linker used to construct the MOF support, the Ni ions stay isolated throughout the hydrogenation catalysis, in accord with its long-term stability. A quantum chemical characterization of the catalyst and the catalytic process complements the experimental results. With validation of computational modeling protocols, we further targeted ethylene oligomerization catalysis by Ni-AIM guided by theoretical prediction. Given the generality of the AIM methodology, this emerging class of materials should prove ripe for the discovery of new catalysts for the transformation of volatile substrates.

  19. Minimal access surgery compared to laparotomy for secondary surgical cytoreduction in patients with recurrent ovarian carcinoma: Perioperative and oncologic outcomes.

    Science.gov (United States)

    Eriksson, Ane Gerda Z; Graul, Ashley; Yu, Miao C; Halko, Anthony; Chi, Dennis S; Zivanovic, Oliver; Gardner, Ginger J; Sonoda, Yukio; Barakat, Richard R; Abu-Rustum, Nadeem R; Leitao, Mario M

    2017-08-01

    To assess the perioperative outcomes of minimal access surgery (MAS) in secondary surgical cytoreduction (SSCR) for recurrent epithelial ovarian cancer (ROC); to compare oncologic outcomes with laparotomy (LAP). Using an institutional database, we identified all patients with ROC undergoing SSCR from 1/5/09-6/14/14. Selection for MAS or LAP was based on surgeon preference. To minimize selection bias, preoperative imaging was reviewed for all LAP cases. In this manner, we identified potential MAS candidates, who were used in the comparison. Intent-to-treat analyses were undertaken using statistical testing. 170 cases were identified (131 LAP, 8 LSC, 31 RBT). 68/131 (52%) LAP cases were deemed potential candidates for MAS. Feasibility analyses included 68 LAP and 39 MAS cases. Six (15%) MAS cases were converted to LAP. Median age, BMI, operative time did not differ significantly between the groups. Complete gross resection was achieved in 37/39 (95%) MAS, 63/68 (93%) LAP (P=1.0). Median estimated blood loss was 50cm 3 (range, 5-500) MAS, 150cm 3 (range, 0-1500) LAP (P=0.001). Median length of stay was 1day (range, 0-23) MAS, 5days (range, 1-21) LAP (P<0.001). Complications occurred in 3/39 (8%) MAS, 15/68 (22%) LAP (P=0.06). The 2-year progression-free survival was 56.1% (SE 9%) MAS, 63.5% (SE 6%) LAP (P=1.0). The 2-year overall survival was 92.2% (SE 5.4%) MAS, 81.4% (SE 5.5%) LAP (P=0.7). MAS for SSCR is feasible in properly selected cases. MAS is associated with favorable perioperative outcomes and similar oncologic outcomes, compared to LAP. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients.

    Science.gov (United States)

    Januszewski, Jacob; Keem, Sean K; Smith, William; Beckman, Joshua M; Kanter, Adam S; Oskuian, Rod J; Taylor, William; Uribe, Juan S

    2017-03-01

    Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies. Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded. Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy. Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Chemoselective single-site Earth-abundant metal catalysts at metal–organic framework nodes

    Energy Technology Data Exchange (ETDEWEB)

    Manna, Kuntal; Ji, Pengfei; Lin, Zekai; Greene, Francis X.; Urban, Ania; Thacker, Nathan C.; Lin, Wenbin (UC)

    2016-08-30

    Earth-abundant metal catalysts are critically needed for sustainable chemical synthesis. Here we report a simple, cheap and effective strategy of producing novel earth-abundant metal catalysts at metal–organic framework (MOF) nodes for broad-scope organic transformations. The straightforward metalation of MOF secondary building units (SBUs) with cobalt and iron salts affords highly active and reusable single-site solid catalysts for a range of organic reactions, including chemoselective borylation, silylation and amination of benzylic C–H bonds, as well as hydrogenation and hydroboration of alkenes and ketones. Our structural, spectroscopic and kinetic studies suggest that chemoselective organic transformations occur on site-isolated, electron-deficient and coordinatively unsaturated metal centres at the SBUs via σ-bond metathesis pathways and as a result of the steric environment around the catalytic site. MOFs thus provide a novel platform for the development of highly active and affordable base metal catalysts for the sustainable synthesis of fine chemicals.

  2. Single-Site Tetracoordinated Aluminum Hydride Supported on Mesoporous Silica. From Dream to Reality!

    KAUST Repository

    Werghi, Baraa

    2016-09-26

    The reaction of mesoporous silica (SBA15) dehydroxylated at 700 °C with diisobutylaluminum hydride, i-Bu2AlH, gives after thermal treatment a single-site tetrahedral aluminum hydride with high selectivity. The starting aluminum isobutyl and the final aluminum hydride have been fully characterized by FT-IR, advanced SS NMR spectroscopy (1H, 13C, multiple quanta (MQ) 2D 1H-1H, and 27Al), and elemental analysis, while DFT calculations provide a rationalization of the occurring reactivity. Trimeric i-Bu2AlH reacts selectively with surface silanols without affecting the siloxane bridges. Its analogous hydride catalyzes ethylene polymerization. Indeed, catalytic tests show that this single aluminum hydride site is active in the production of a high-density polyethylene (HDPE). © 2016 American Chemical Society.

  3. Chemoselective single-site Earth-abundant metal catalysts at metal-organic framework nodes.

    Science.gov (United States)

    Manna, Kuntal; Ji, Pengfei; Lin, Zekai; Greene, Francis X; Urban, Ania; Thacker, Nathan C; Lin, Wenbin

    2016-08-30

    Earth-abundant metal catalysts are critically needed for sustainable chemical synthesis. Here we report a simple, cheap and effective strategy of producing novel earth-abundant metal catalysts at metal-organic framework (MOF) nodes for broad-scope organic transformations. The straightforward metalation of MOF secondary building units (SBUs) with cobalt and iron salts affords highly active and reusable single-site solid catalysts for a range of organic reactions, including chemoselective borylation, silylation and amination of benzylic C-H bonds, as well as hydrogenation and hydroboration of alkenes and ketones. Our structural, spectroscopic and kinetic studies suggest that chemoselective organic transformations occur on site-isolated, electron-deficient and coordinatively unsaturated metal centres at the SBUs via σ-bond metathesis pathways and as a result of the steric environment around the catalytic site. MOFs thus provide a novel platform for the development of highly active and affordable base metal catalysts for the sustainable synthesis of fine chemicals.

  4. Single-site SBA-15 supported zirconium catalysts. Synthesis, characterization and toward cyanosilylation reaction

    International Nuclear Information System (INIS)

    Xu, Wei; Yu, Bo; Zhang, Ying; Chen, Xi; Zhang, Guofang; Gao, Ziwei

    2015-01-01

    Graphical abstract: Ligand-modified signal-site SBA-15 supported zirconium catalysts were synthesized by SOMC method and characterized by a variety of techniques. The zirconium surface complexes show high catalytic efficiency for cyanosilylation of benzaldehyde. - Highlights: • Some Zr active species have been anchored on the surface of SBA-15 by SOMC technique. • The structures of the Zr species have been characterized by a variety of techniques. • The anchored Zr species are single-sited surface complexes. • The Zr surface complexes are catalytic active for cyanosilylation of benzaldehyde. - Abstract: A successive anchoring of Zr(NMe 2 ) 4 , cyclopentadiene and a O-donor ligand, 1-hydroxyethylbenzene (PEA), 1,1′-bi-2-naphthol (Binol) or 2,3-dihydroxybutanedioic acid diethyl ester (Tartrate), on dehydroxylated SBA-15 pretreated at 500 °C for 16 h (SBA-15 -500 ) was conducted by SOMC strategy in moderate conditions. The dehydoxylation of SBA-15 was monitored by in situ Fourier transform infrared spectroscopy (in situ FT-IR). The ligand-modified SBA-15 -500 supported zirconium complexes were characterized by in situ FT-IR, 13 C CP MAS-NMR, X-ray photoelectron spectroscopy (XPS), inductively coupled plasma mass spectrometry (ICP-MAS) and elemental analysis in detail, verifying that the surface zirconium species are single-sited. The catalytic activity of these complexes was evaluated by cyanosilylation of benzaldehyde. The results showed that the catalytic activity is dependent strongly on the structure of surface species and the configuration of the ligands

  5. Single-site SBA-15 supported zirconium catalysts. Synthesis, characterization and toward cyanosilylation reaction

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Wei; Yu, Bo; Zhang, Ying; Chen, Xi; Zhang, Guofang, E-mail: gfzhang@snnu.edu.cn; Gao, Ziwei, E-mail: zwgao@snnu.edu.cn

    2015-01-15

    Graphical abstract: Ligand-modified signal-site SBA-15 supported zirconium catalysts were synthesized by SOMC method and characterized by a variety of techniques. The zirconium surface complexes show high catalytic efficiency for cyanosilylation of benzaldehyde. - Highlights: • Some Zr active species have been anchored on the surface of SBA-15 by SOMC technique. • The structures of the Zr species have been characterized by a variety of techniques. • The anchored Zr species are single-sited surface complexes. • The Zr surface complexes are catalytic active for cyanosilylation of benzaldehyde. - Abstract: A successive anchoring of Zr(NMe{sub 2}){sub 4}, cyclopentadiene and a O-donor ligand, 1-hydroxyethylbenzene (PEA), 1,1′-bi-2-naphthol (Binol) or 2,3-dihydroxybutanedioic acid diethyl ester (Tartrate), on dehydroxylated SBA-15 pretreated at 500 °C for 16 h (SBA-15{sub -500}) was conducted by SOMC strategy in moderate conditions. The dehydoxylation of SBA-15 was monitored by in situ Fourier transform infrared spectroscopy (in situ FT-IR). The ligand-modified SBA-15{sub -500} supported zirconium complexes were characterized by in situ FT-IR, {sup 13}C CP MAS-NMR, X-ray photoelectron spectroscopy (XPS), inductively coupled plasma mass spectrometry (ICP-MAS) and elemental analysis in detail, verifying that the surface zirconium species are single-sited. The catalytic activity of these complexes was evaluated by cyanosilylation of benzaldehyde. The results showed that the catalytic activity is dependent strongly on the structure of surface species and the configuration of the ligands.

  6. Development of a novel robotic platform with controllable stiffness manipulation arms for laparoendoscopic single-site surgery (LESS).

    Science.gov (United States)

    Wang, Jianchen; Wang, Shuxin; Li, Jinhua; Ren, Xiangyun; Briggs, Randall Miller

    2018-02-01

    For current LESS robotic systems, the trade-off between dexterity and payload capability is always present. This paper presents a novel LESS robotic platform equipped with controllable stiffness manipulation arms. Each manipulation arm with an articulated section and a controllable stiffness continuum section (CSCS) can be switched between a 7-DoF compliant status and 5-DoF rigid status according to the operation requirement. Screw theory and product exponential formula are used to quantify the kinematic performance. The stiffness of the manipulation arm promotes 3.03 to 4.12 times from compliant to rigid CSCS with maximum payload of 10 N in rigid status. The shortest rigid/compliant switching time is 5 s. The precision of a tracking test and an ex vivo procedure verified the accuracy and effectiveness of the controllable stiffness manipulation arms. This robot could potentially improve the surgical performance and further expand robotic LESS procedures. Copyright © 2017 John Wiley & Sons, Ltd.

  7. Catalysis by Design: Well-Defined Single-Site Heterogeneous Catalysts

    KAUST Repository

    Pelletier, Jeremie

    2016-03-09

    ConspectusHeterogeneous catalysis, a field important industrially and scientifically, is increasingly seeking and refining strategies to render itself more predictable. The main issue is due to the nature and the population of catalytically active sites. Their number is generally low to very low, their "acid strengths" or " redox properties" are not homogeneous, and the material may display related yet inactive sites on the same material. In many heterogeneous catalysts, the discovery of a structure-activity reationship is at best challenging. One possible solution is to generate single-site catalysts in which most, if not all, of the sites are structurally identical. Within this context and using the right tools, the catalyst structure can be designed and well-defined, to reach a molecular understanding. It is then feasible to understand the structure-activity relationship and to develop predictable heterogeneous catalysis. Single-site well-defined heterogeneous catalysts can be prepared using concepts and tools of surface organometallic chemistry (SOMC). This approach operates by reacting organometallic compounds with surfaces of highly divided oxides (or of metal nanoparticles). This strategy has a solid track record to reveal structure-activity relationship to the extent that it is becoming now quite predictable. Almost all elements of the periodical table have been grafted on surfaces of oxides (from simple oxides such as silica or alumina to more sophisticated materials regarding composition or porosity).Considering catalytic hydrocarbon transformations, heterogeneous catalysis outcome may now be predicted based on existing mechanistic proposals and the rules of molecular chemistry (organometallic, organic) associated with some concepts of surface sciences. A thorough characterization of the grafted metal centers must be carried out using tools spanning from molecular organometallic or surface chemistry. By selection of the metal, its ligand set, and the

  8. Catalysis by Design: Well-Defined Single-Site Heterogeneous Catalysts.

    Science.gov (United States)

    Pelletier, Jérémie D A; Basset, Jean-Marie

    2016-04-19

    Heterogeneous catalysis, a field important industrially and scientifically, is increasingly seeking and refining strategies to render itself more predictable. The main issue is due to the nature and the population of catalytically active sites. Their number is generally low to very low, their "acid strengths" or " redox properties" are not homogeneous, and the material may display related yet inactive sites on the same material. In many heterogeneous catalysts, the discovery of a structure-activity reationship is at best challenging. One possible solution is to generate single-site catalysts in which most, if not all, of the sites are structurally identical. Within this context and using the right tools, the catalyst structure can be designed and well-defined, to reach a molecular understanding. It is then feasible to understand the structure-activity relationship and to develop predictable heterogeneous catalysis. Single-site well-defined heterogeneous catalysts can be prepared using concepts and tools of surface organometallic chemistry (SOMC). This approach operates by reacting organometallic compounds with surfaces of highly divided oxides (or of metal nanoparticles). This strategy has a solid track record to reveal structure-activity relationship to the extent that it is becoming now quite predictable. Almost all elements of the periodical table have been grafted on surfaces of oxides (from simple oxides such as silica or alumina to more sophisticated materials regarding composition or porosity). Considering catalytic hydrocarbon transformations, heterogeneous catalysis outcome may now be predicted based on existing mechanistic proposals and the rules of molecular chemistry (organometallic, organic) associated with some concepts of surface sciences. A thorough characterization of the grafted metal centers must be carried out using tools spanning from molecular organometallic or surface chemistry. By selection of the metal, its ligand set, and the support taken

  9. Well-defined silica supported aluminum hydride: another step towards the utopian single site dream?

    Science.gov (United States)

    Werghi, Baraa; Bendjeriou-Sedjerari, Anissa; Sofack-Kreutzer, Julien; Jedidi, Abdesslem; Abou-Hamad, Edy; Cavallo, Luigi; Basset, Jean-Marie

    2015-10-01

    processes occur by opening of a strained siloxane bridge, Si-O-Si but with two different mechanisms, showing that the reality of "single site" catalyst may be an utopia: DFT calculations indicate that isobutyl transfer occurs via a simple metathesis between the Al-isobutyl and O-Si bonds, while hydride transfer occurs via a two steps mechanism, the first one is a β-H elimination to Al with elimination of isobutene, whereas the second is a metathesis step between the formed Al-H bond and a O-Si bond. Thermal treatment of 1a (at 250 °C) under high vacuum (10 -5 mbar) generates Al-H through a β-H elimination of isobutyl fragment. These supported well-defined Al-H which are highly stable with time, are tetra, penta and octa coordinated as demonstrated by IR and 27 Al- 1 H J-HMQC NMR spectroscopy. All these observations indicate that surfaces atoms around the site of grafting play a considerable role in the reactivity of a single site system.

  10. Evidence that adaptation in Drosophila is not limited by mutation at single sites.

    Directory of Open Access Journals (Sweden)

    Talia Karasov

    2010-06-01

    Full Text Available Adaptation in eukaryotes is generally assumed to be mutation-limited because of small effective population sizes. This view is difficult to reconcile, however, with the observation that adaptation to anthropogenic changes, such as the introduction of pesticides, can occur very rapidly. Here we investigate adaptation at a key insecticide resistance locus (Ace in Drosophila melanogaster and show that multiple simple and complex resistance alleles evolved quickly and repeatedly within individual populations. Our results imply that the current effective population size of modern D. melanogaster populations is likely to be substantially larger (> or = 100-fold than commonly believed. This discrepancy arises because estimates of the effective population size are generally derived from levels of standing variation and thus reveal long-term population dynamics dominated by sharp--even if infrequent--bottlenecks. The short-term effective population sizes relevant for strong adaptation, on the other hand, might be much closer to census population sizes. Adaptation in Drosophila may therefore not be limited by waiting for mutations at single sites, and complex adaptive alleles can be generated quickly without fixation of intermediate states. Adaptive events should also commonly involve the simultaneous rise in frequency of independently generated adaptive mutations. These so-called soft sweeps have very distinct effects on the linked neutral polymorphisms compared to the standard hard sweeps in mutation-limited scenarios. Methods for the mapping of adaptive mutations or association mapping of evolutionarily relevant mutations may thus need to be reconsidered.

  11. Single-site Lennard-Jones models via polynomial chaos surrogates of Monte Carlo molecular simulation

    KAUST Repository

    Kadoura, Ahmad Salim

    2016-06-01

    In this work, two Polynomial Chaos (PC) surrogates were generated to reproduce Monte Carlo (MC) molecular simulation results of the canonical (single-phase) and the NVT-Gibbs (two-phase) ensembles for a system of normalized structureless Lennard-Jones (LJ) particles. The main advantage of such surrogates, once generated, is the capability of accurately computing the needed thermodynamic quantities in a few seconds, thus efficiently replacing the computationally expensive MC molecular simulations. Benefiting from the tremendous computational time reduction, the PC surrogates were used to conduct large-scale optimization in order to propose single-site LJ models for several simple molecules. Experimental data, a set of supercritical isotherms, and part of the two-phase envelope, of several pure components were used for tuning the LJ parameters (ε, σ). Based on the conducted optimization, excellent fit was obtained for different noble gases (Ar, Kr, and Xe) and other small molecules (CH4, N2, and CO). On the other hand, due to the simplicity of the LJ model used, dramatic deviations between simulation and experimental data were observed, especially in the two-phase region, for more complex molecules such as CO2 and C2 H6.

  12. Laparoendoscopic Single-Site Plus One-Port Donor Nephrectomy: Analysis of 169 Cases.

    Science.gov (United States)

    Cho, Hyuk Jin; Choi, Sae Woong; Kim, Kang Sup; Park, Yong Hyun; Bae, Woong Jin; Hong, Sung-Hoo; Lee, Ji Youl; Kim, Sae Woong; Hwang, Tae-Kon

    2015-08-01

    To present our experience with laparoendoscopic single-site plus one-port donor nephrectomy (LESSOP-DN) and compare the outcomes with laparoscopic donor nephrectomy (LDN). Prospectively collected data from 169 consecutive LESSOP-DNs and 83 LDNs performed by a single surgeon in the same time period were analyzed retrospectively. No differences in mean operative time (136 versus 130 minutes; P=.15), warm ischemia time (3.4 versus 3.5 minutes; P=.42), blood loss (50 versus 45 mL; P=.41), transfusion rates (0 versus 1 case), hospital stay (4.0 versus 3.9 days; P=.48), or overall complication rate (12.0% versus 7.7%; P=.25) were observed between the LDN and LESSOP-DN groups. The LESSOP-DN group had a shorter time to return to 100% recovery (39 versus 74 days; Pa smaller surgical incision (5.5 versus 8.2 cm; Pgroup. Renal function of the recipient based on estimated glomerular filtration rate at 1 and 3 months was similar between the groups. Health-related quality of life (QOL) was significantly higher in the LESSOP-DN group in four domains of the health survey than in the LDN group. LESSOP-DN might be associated with smaller surgical incision, improved cosmetic satisfaction, less time to recovery, less analgesic requirement, improved donor QOL, and equivalent recipient graft function.

  13. A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors.

    Science.gov (United States)

    Lin, Victor Chia-Hsiang; Tsai, Yao-Chou; Chung, Shiu-Dong; Li, Tin Chou; Ho, Chen-Hsun; Jaw, Fu-Shan; Tai, Huai-Ching; Yu, Hong-Jeng

    2012-04-01

    The safety and feasibility of laparoendoscopic single-site (LESS) adrenalectomy for benign adrenal lesions was proved in early clinical series. However, the advantages of LESS over multiport laparoscopic adrenalectomy still are under investigation. Since October 2009, the authors have prospectively performed LESS retroperitoneal adrenalectomy for 21 consecutive patients with benign adrenal tumors (LESS group). Another 28 patients with benign adrenal tumors were prospectively collected between June 2006 and October 2009 and served as a multiport laparoscopic adrenalectomy group. The patients' demographic data, operating time, estimated blood loss, peri- and postoperative complications, and short-term outcome were collected for further analysis. The demographic data were comparable between the two groups in terms of the patient age, gender, body mass index (BMI), laterality, diagnosis, and resected specimen weight. No major complication or mortality occurred in either group. Neither group had any conversions. No differences were observed between the two groups in terms of intraoperative hemodynamic status or peri- or postoperative complications. The LESS patients had quicker resumption of oral intake (0.18 vs 1 day; p benign adrenal tumors. In addition, LESS adrenalectomy provides short-term convalescence advantages over multiport laparoscopic adrenalectomy.

  14. Induction of prophage lambda by chlorinated organics: Detection of some single-species/single-site carcinogens

    Energy Technology Data Exchange (ETDEWEB)

    DeMarini, D.M.; Brooks, H.G. (Environmental Protection Agency, Research Triangle Park, NC (United States))

    1992-01-01

    Twenty-eight chlorinated organic compounds were evaluated for their ability to induce DNA damage using the Microscreen prophage-induction assay in Escherichia coli. Comparison of the performance characteristics of the prophage-induction and Salmonella assays to rodent carcinogenicity assays showed that the prophage-induction assay had a somewhat higher specificity than did the Salmonella assay (70% vs. 50%); sensitivity, concordance, and positive and negative predictivity were similar for the two microbial assays. The Microscreen prophage-induction assay failed to detect eight carcinogens, perhaps due to toxicity or other unknown factors; five of these eight carcinogens were detected by the Salmonella assay. However, the prophage-induction assay did detect six carcinogens that were not detected by the Salmonella assay, and five of these were single-species, single-site carcinogens, mostly mouse liver carcinogens. Some of these carcinogens, such as the chloroethanes, produce free radicals, which may be the basis for their carcinogenicity and ability to induce prophage. The prophage-induction (or other SOS) assay may be useful in identifying some genotoxic chlorinated carcinogens that induce DNA damage that do not revert the standard Salmonella tester strains.

  15. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation.

    Science.gov (United States)

    Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter

    2017-12-01

    To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Performance analysis of high frequency single-site-location antenna arrays using numerical electromagnetic modeling

    Science.gov (United States)

    Schiantarelli, Harry T.

    1990-09-01

    Electronic support measures (ESM) systems play an increasingly important role in modern warfare and can influence the outcome of a military engagement. The application of ESM can be extended to anti-guerrilla and anti-drug operations where law enforcement agencies can exploit the fact that their presence is inducing the outlaw to depend more on radio communications to coordinate their activities. When a propagation path of no more than one reflection at the ionosphere (1-hop) can be assumed, position of an HF emitter can be determined by a single observing site using vertical triangulation, provided that the height of the ionosphere at the point where the radio wave is reflected, can be determined. This technique is known as high frequency direction finding single-site-location (HFDF SSL). This thesis analyzes the HFDF SSL error in measuring the direction of arrival of the signal, how this error is generated by the antenna array and its effect on emitter location. The characteristics of the two antenna arrays used by a specific HFDF SSL system that implements the phase-interferometer techniques were studied using electromagnetic modeling.

  17. Single-site SBA-15 supported zirconium catalysts. Synthesis, characterization and toward cyanosilylation reaction

    Science.gov (United States)

    Xu, Wei; Yu, Bo; Zhang, Ying; Chen, Xi; Zhang, Guofang; Gao, Ziwei

    2015-01-01

    A successive anchoring of Zr(NMe2)4, cyclopentadiene and a O-donor ligand, 1-hydroxyethylbenzene (PEA), 1,1‧-bi-2-naphthol (Binol) or 2,3-dihydroxybutanedioic acid diethyl ester (Tartrate), on dehydroxylated SBA-15 pretreated at 500 °C for 16 h (SBA-15-500) was conducted by SOMC strategy in moderate conditions. The dehydoxylation of SBA-15 was monitored by in situ Fourier transform infrared spectroscopy (in situ FT-IR). The ligand-modified SBA-15-500 supported zirconium complexes were characterized by in situ FT-IR, 13C CP MAS-NMR, X-ray photoelectron spectroscopy (XPS), inductively coupled plasma mass spectrometry (ICP-MAS) and elemental analysis in detail, verifying that the surface zirconium species are single-sited. The catalytic activity of these complexes was evaluated by cyanosilylation of benzaldehyde. The results showed that the catalytic activity is dependent strongly on the structure of surface species and the configuration of the ligands.

  18. Single-site Green function of the Dirac equation for full-potential electron scattering

    Energy Technology Data Exchange (ETDEWEB)

    Kordt, Pascal

    2012-05-30

    I present an elaborated analytical examination of the Green function of an electron scattered at a single-site potential, for both the Schroedinger and the Dirac equation, followed by an efficient numerical solution, in both cases for potentials of arbitrary shape without an atomic sphere approximation. A numerically stable way to calculate the corresponding regular and irregular wave functions and the Green function is via the angular Lippmann-Schwinger integral equations. These are solved based on an expansion in Chebyshev polynomials and their recursion relations, allowing to rewrite the Lippmann-Schwinger equations into a system of algebraic linear equations. Gonzales et al. developed this method for the Schroedinger equation, where it gives a much higher accuracy compared to previous perturbation methods, with only modest increase in computational effort. In order to apply it to the Dirac equation, I developed relativistic Lippmann-Schwinger equations, based on a decomposition of the potential matrix into spin spherical harmonics, exploiting certain properties of this matrix. The resulting method was embedded into a Korringa-Kohn-Rostoker code for density functional calculations. As an example, the method is applied by calculating phase shifts and the Mott scattering of a tungsten impurity. (orig.)

  19. Hanford Site Welding Program Successfully Providing A Single Site Function For Use By Multiple Contractors

    International Nuclear Information System (INIS)

    Cannell, G.R.

    2009-01-01

    The Department of Energy, Richland Operations (DOE-RL) recently restructured its Hanford work scope, awarding two new contracts over the past several months for a total of three contracts to manage the sites cleanup efforts. DOE-RL met with key contractor personnel prior to and during contract transition to ensure site welding activities had appropriate oversight and maintained code compliance. The transition also provided an opportunity to establish a single site-wide function that would provide welding and materials engineering services to the Hanford site contractors: CH2M HILL Plateau Remediation Company (CHPRC); Mission Support Alliance (MSA); Washington River Protection Solutions (WRPS); and Washington Closure Hanford (WCH). Over the years, multiple and separate welding programs (amongst the several contractors) existed at the Hanford site leading to inefficiencies resulting from duplication of administrative efforts, maintenance of welding procedures, welder performance certifications, etc. The new, single program eliminates these inefficiencies. The new program, co-managed by two of the sites' new contractors, the CHPRC ('owner' of the program and responsible for construction welding services) and the MSA (provides maintenance welding services), provides more than just the traditional construction and maintenance welding services. Also provided, are welding engineering, specialty welding development/qualification for the closure of radioactive materials containers and materials evaluation/failure analysis. The following describes the new Hanford site welding program.

  20. Defining the learning curve of laparoendoscopic single-site Heller myotomy.

    Science.gov (United States)

    Ross, Sharona B; Luberice, Kenneth; Kurian, Tony J; Paul, Harold; Rosemurgy, Alexander S

    2013-08-01

    Initial outcomes suggest laparoendoscopic single-site (LESS) Heller myotomy with anterior fundoplication provides safe, efficacious, and cosmetically superior outcomes relative to conventional laparoscopy. This study was undertaken to define the learning curve of LESS Heller myotomy with anterior fundoplication. One hundred patients underwent LESS Heller myotomy with anterior fundoplication. Symptom frequency and severity were scored using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Symptom resolution, additional trocars, and complications were compared among patient quartiles. Median data are presented. Preoperative frequency/severity scores were: dysphagia = 10/8 and regurgitation = 8/7. Additional trocars were placed in 12 patients (10%), of whom all were in the first two quartiles. Esophagotomy/gastrotomy occurred in three patients. Postoperative complications occurred in 9 per cent. No conversions to "open" operations occurred. Length of stay was 1 day. Postoperative frequency/severity scores were: dysphagia = 2/0 and regurgitation = 0/0; scores were less than before myotomy (P learning curve of LESS Heller myotomy with anterior fundoplication is short and safe, because proficiency is quickly attained.

  1. A Global Assessment of Access to and Use of Medical Information: The State of Evidence-Based Surgery.

    Science.gov (United States)

    LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Langdale, Lorrie A; Fuangworawong, Phupit; Hamasaki, Jose Luis; Gyedu, Adam; Mock, Charles N

    2018-02-01

    We aimed to assess surgeons' access to and use of medical information, as well as their training and perceptions about evidence-based medicine (EBM), in order to identify priority areas for improvement. An anonymous survey conducted among surgeons from the USA, Ghana, Peru, and Thailand examined access to, and use and perception of, medical literature. Of 307 participants, 98% reported access to "OK" or "good" internet. Fifty-one percent reported that language was a barrier to accessing needed medical information; most frequently in Peru (73%) and Thailand (64%). Access to priced full-text journals was poorest in Peru, where 54% lacked access, followed by Ghana (42%) and Thailand (32%). US respondents scored highest on the EBM knowledge test (1.4, SD 0.8), followed by Thailand (1.3, SD 0.9), Ghana (1.1, SD 0.8), and Peru (0.9, SD 0.8) (p information, respectively, relative to country income, than persons from other countries (p access to priced full-text journals, and training are significant barriers to surgeons' practice of EBM globally. The way forward involves collaboration among surgical societies, publishers, hospital employers, and international policymakers in providing surgeons from all country income levels with the access and training necessary to interpret and apply medical information.

  2. Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy.

    Science.gov (United States)

    Redondo, C; Esquinas, C; Meilán, E; García-Tello, A; Arance, I; Angulo, J C

    2017-05-01

    To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Hybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Laparoendoscopic single-site gastric bands versus standard multiport gastric bands: a comparison of technical learning curve measured by surgical time.

    Science.gov (United States)

    Gawart, Matthew; Dupitron, Sabine; Lutfi, Rami

    2012-03-01

    We aimed to evaluate our learning curve comparing surgical time of laparoendoscopic single-site (LESS) banding with multiport laparoscopy. We performed a retrospective analysis of prospectively collected data comparing our first 48 LESS bands with our first 50 multiport laparoscopic bands at our institution. We then compared the first 24 LESS bands with the last 24 bands. The average body mass index for the LESS group was significantly lower than for the laparoscopic group (43.19 vs 48.3; P < .0001). The surgical time was much faster toward the second half of our experience performing the LESS procedure (85.34 vs 68.8; P = .0055). LESS banding took significantly longer than our early traditional laparoscopic adjustable gastric banding (76.85 vs 64.4; P = .0015). We conclude that in experienced hands, single-incision banding is feasible and safe to perform. Long-term data are needed to prove that LESS banding is as good a surgery as traditional laparoscopic surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost.

    Science.gov (United States)

    Fujii, Shoichi; Watanabe, Kazuteru; Ota, Mitsuyoshi; Watanabe, Jun; Ichikawa, Yasushi; Yamagishi, Shigeru; Tatsumi, Kenji; Suwa, Hirokazu; Kunisaki, Chikara; Taguri, Masataka; Morita, Satoshi; Endo, Itaru

    2012-05-01

    Single-incision laparoscopic surgery (SILS) has been used for colorectal cancer as a minimally invasive procedure. However, there are still difficulties concerning effective triangulation and countertraction. The study's purpose was to clarify the usefulness of the colon-lifting technique (CLT) in SILS for colorectal cancer. SILS was performed for cancer (cT2N0 or less) of the right-sided colon (near the ileocecum), sigmoid, or rectosigmoid. The SILS™ Port was used for transumbilical access. A suture string was inserted through the abdominal wall and passed through the mesocolon. The colon was retracted anteriorly and fixed to the abdominal wall. The main mesenteric vessels were placed under tension. Lymph node dissection was performed by medial approach. Short-term surgical outcomes and access port costs were compared between SILS (using CLT) and the standard multiport technique (MPT). The two groups were case-matched by propensity scoring. Analyzed variables included preoperative Dukes stage and tumor location. From June 2009 to April 2011, 27 patients underwent SILS, and from April 2005 to April 2011, 85 patients underwent MPT. Propensity scoring generated 23 matched patients per group for SILS versus MPT comparisons. There were no significant differences in operating time, blood loss, early complications, postoperative analgesic frequency, or length of hospital stay. One MPT patient was converted to open surgery (4.5%); no SILS patients were converted. There were no significant differences in the length of distal cut margin and the number of harvested lymph nodes, except incision length (SILS vs. MPT: 33 vs. 55 mm, P Japanese yen, P CLT was safe and effective in providing radical treatment of cT2N0 cancer in the right-sided colon, sigmoid, or rectosigmoid. SILS was advantageous with respect to cosmesis and lower cost of access instruments.

  5. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time

    Directory of Open Access Journals (Sweden)

    Santori Gregorio

    2009-01-01

    Full Text Available Abstract Background Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs associated with Maximum Time Before Treatment (MTBT, similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery. Methods In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1 urgency assessment into URGs; 2 correspondent assignment of a pre-set MTBT; 3 real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases. From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list and Appropriate Performance Index (API. Results The SWALIS pre-admission model was used for all registrations in the

  6. Well-Defined Silica Supported Aluminum Hydride: Another Step Towards the Utopian Single Site Dream?

    KAUST Repository

    Werghi, Baraa

    2015-07-17

    Reaction of triisobutylaluminum with SBA15700 at room temperature occurs by two parallel pathways involving either silanol or siloxane bridges. It leads to the formation of a well-defined bipodal [(≡SiO)2Al-CH2CH(CH3)2] 1a, silicon isobutyl [≡Si-CH2CH(CH3)2] 1b and a silicon hydride [≡Si-H] 1c. Their structural identity was characterized by FT-IR and advance solid-state NMR spectroscopies (1H, 13C, 29Si, 27Al and 2D multiple quantum), elemental and gas phase analysis, and DFT calculations. The reaction involves the formation of a highly reactive monopodal intermediate: [≡SiO-Al-[CH2CH(CH3)2]2], with evolution of isobutane. This intermediate undergoes two parallel routes: Transfer of either one isobutyl fragment or of one hydride to an adjacent silicon atom. Both processes occur by opening of a strained siloxane bridge, ≡Si-O-Si≡ but with two different mechanisms, showing that the reality of “single site” catalyst may be an utopia: DFT calculations indicate that isobutyl transfer occurs via a simple metathesis between the Al-isobutyl and O-Si bonds, while hydride transfer occurs via a two steps mechanism, the first one is a ß-H elimination to Al with elimination of isobutene, whereas the second is a metathesis step between the formed Al-H bond and a O-Si bond. Thermal treatment of 1a (at 250 °C) under high vacuum (10-5 mbar) generates Al-H through a ß-H elimination of isobutyl fragment. These supported well-defined Al-H which are highly stable with time, are tetra, penta and octa coordinated as demonstrated by IR and 27Al–1H J-HMQC NMR spectroscopy. All these observations indicate that surfaces atoms around the site of grafting play a considerable role in the reactivity of a single site system.

  7. The influence of social media and easily accessible online information on the aesthetic plastic surgery practice: literature review and our own experience.

    Science.gov (United States)

    Montemurro, Paolo; Porcnik, Ales; Hedén, Per; Otte, Maximilian

    2015-04-01

    Patients interested in aesthetic plastic surgery procedures increasingly seek advice on social media and rely on easily accessible online information. The investigatory goal was to determine the impact of this phenomenon on the everyday aesthetic plastic surgery practice. Five hundred consecutive patients completed a questionnaire prior to their consultation with a plastic surgeon at our clinic. A questionnaire was also completed by 128 plastic surgeons practising in 19 different countries. A literature review was performed. Almost all patients (95%) used the internet to collect information prior to consultation, for 68% of them it being their first search method. Social media were used by 46% of patients and 40% of these were strongly influenced when choosing a specific doctor. The majority of plastic surgeons (85%) thought the information found on social media could lead to unrealistic expectations. However, 45% of plastic surgeons believed that their consultations became easier after the advent of social media, 29% found them more difficult. A literature review showed a high percentage of poor quality internet websites regarding plastic surgery and an increase in use of social media among plastic surgeons. The internet and social media play an important and growing role in plastic surgery. This results in more informed patients but may create unrealistic expectations. Even if the internet provides ample information, it cannot replace the face-to-face consultation, which always should remain a detailed process, covering both risks and limitations of alternative procedures. Available literature on how social media influences the medical practice is still scarce and further research is needed. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  8. SURGERY FOR TUMORS OF THE FOURTH VENTRICLE: THE CHARACTERISTICS OF ACCESSES AND THE ROLE OF ENDOSCOPIC TECHNIQUES

    Directory of Open Access Journals (Sweden)

    V. B. Karakhan

    2012-01-01

    Full Text Available The use of current accesses to the tumors of the fourth ventricle, which fill and compress from the outside its cavity, was assessed in 28 patients. Original associated endomicrosurgical techniques were used. Two groups and five topographic types of fourth ventricle tumors are identified. Basic accesses — telovelar and supracerebellar — eliminate the necessity of dissecting the vermis cerebelli. The key endoscopic technique is to provide a simultaneous survey of the lower and upper poles of a tumor during its removal. The technique of trochlear removal of metastatic nodes from the fourth ventricle is shown. The benefits of endoscopic techniques are to early examine the vulnerable vascular and neural structures blocked by a tumor at the access step; to reduce the volume of an access itself and the traction of cerebellar and truncal structures; to completely survey the Sylvian aqueduct without additionally displacing or dissecting the vermis cerebelli; to maintain optical sharpness within sight of differently remote microstructures. Overall, incorporation of the endoscopic method realizes the principle of mini-invasive neurosurgery. 

  9. Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J: An Experimental Study of a Novel Approach

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Vahdad

    2015-09-01

    Full Text Available Background: The natural orifice transluminal endoscopic surgery (NOTES has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy. Method: Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA® and sutured to the rectal wall. Results: All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis. Conclusion: The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early.

  10. Bis(benzimidazole)amine vanadium catalysts for olefin polymerisation and co-polymerisation: thermally robust, single-site catalysts activated by simple alkylaluminium reagents.

    Science.gov (United States)

    Tomov, Atanas K; Gibson, Vernon C; Zaher, Damien; Elsegood, Mark R J; Dale, Sophie H

    2004-09-07

    Vanadium complexes containing bis(benzimidazole)amine ligands, upon activation by simple alkylaluminium reagents, give unusually robust, single-site, catalysts for olefin polymerisation/co-polymerisation.

  11. Real-Time Visualization of Active Species in a Single-Site Metal–Organic Framework Photocatalyst

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Sizhuo [Department of Chemistry, Marquette University, Milwaukee, Wisconsin 53201, United States; Pattengale, Brian [Department of Chemistry, Marquette University, Milwaukee, Wisconsin 53201, United States; Lee, Sungsik [X-ray Science Division, Argonne National Laboratory, Argonne, Illinois 60349, United States; Huang, Jier [Department of Chemistry, Marquette University, Milwaukee, Wisconsin 53201, United States

    2018-02-06

    In this work, we report a new single-site photocatalyst (Co-Ru-UIO- 67(bpy)) based on a metal-organic framework platform with incorporated molecular photosensitizer and catalyst. We show that this catalyst not only demonstrates exceptional activity for light-driven H2 production but also can be recycled without loss of activity. Using the combination of optical transient absorption spectroscopy and in situ X-ray absorption spectroscopy, we not only captured the key CoI intermediate species formed after ultrafast charge transfer from the incorporated photosensitizer but also identified the rate-limiting step in the catalytic cycle, providing insight into the catalysis mechanism of these single-site metal-organic framework photocatalysts.

  12. Highly efficient one-step conversion of cyclohexane to adipic acid using single-site heterogeneous catalysts.

    Science.gov (United States)

    Raja, Robert; Thomas, John Meurig; Xu, Mingcan; Harris, Kenneth D M; Greenhill-Hooper, Michael; Quill, Kieran

    2006-01-28

    A solid source of 'active' oxygen (acetylperoxyborate, APB), when dissolved in aqueous solution in the presence of a single-site microporous catalyst containing redox centres (Fe(III)AlPO-31, Mn(III)AlPO-5, Fe(III)AlPO-5), converts cyclohexane with high efficiency (ca. 88%) and exceptionally high selectivity (ca. 81%) to adipic acid at 383 K; this procedure is also effective in converting styrene to styrene oxide and -pinene and (+)-limonene to their corresponding epoxides.

  13. Homogeneity of Surface Sites in Supported Single-Site Metal Catalysts: Assessment with Band Widths of Metal Carbonyl Infrared Spectra.

    Science.gov (United States)

    Hoffman, Adam S; Fang, Chia-Yu; Gates, Bruce C

    2016-10-06

    Determining and controlling the uniformity of isolated metal sites on surfaces of supports are central goals in investigations of single-site catalysts because well-defined species provide opportunities for fundamental understanding of the surface sites. CO is a useful probe of surface metal sites, often reacting with them to form metal carbonyls, the infrared spectra of which provide insights into the nature of the sites and the metal-support interface. Metals bonded to various support surface sites give broad bands in the spectra, and when narrow bands are observed, they indicate a high degree of uniformity of the metal sites. Much recent work on single-site catalysts has been done with supports that are inherently nonuniform, giving supported metal species that are therefore nonuniform. Herein we summarize values of ν CO data characterizing supported iridium gem-dicarbonyls, showing that the most nearly uniform of them are those supported on zeolites and the least uniform are those supported on metal oxides. Guided by ν CO data of supported iridium gem-dicarbonyls, we have determined new, general synthesis methods to maximize the degree of uniformity of iridium species on zeolites and on MgO. We report results for a zeolite HY-supported iridium gem-dicarbonyl with full width at half-maximum values of only 4.6 and 5.2 cm -1 characterizing the symmetric and asymmetric CO stretches and implying that this is the most nearly uniform supported single-site metal catalyst.

  14. Patient cost-sharing and insurance arrangements are associated with hospital readmissions after abdominal surgery: Implications for access and quality health care.

    Science.gov (United States)

    Youn, Bora; Soley-Bori, Marina; Soria-Saucedo, Rene; Ryan, Colleen M; Schneider, Jeffrey C; Haynes, Alex B; Cabral, Howard J; Kazis, Lewis E

    2016-03-01

    Readmission rates after operative procedures are used increasingly as a measure of hospital care quality. Patient access to care may influence readmission rates. The objective of this study was to determine the relationship between patient cost-sharing, insurance arrangements, and the risk of postoperative readmissions. Using the MarketScan Research Database (n = 121,002), we examined privately insured, nonelderly patients who underwent abdominal surgery in 2010. The main outcome measures were risk-adjusted unplanned readmissions within 7 days and 30 days of discharge. Odds of readmissions were compared with multivariable logistic regression models. In adjusted models, $1,284 increase in patient out-of-pocket payments during index admission (a difference of one standard deviation) was associated with 19% decrease in the odds of 7-day readmission (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.78-0.85) and 17% decrease in the odds of 30-day readmission (OR 0.83, 95% CI 0.81-0.86). Patients in the noncapitated point-of-service plans (OR 1.19, 95% CI 1.07-1.33), preferred provider organization plans (OR 1.11, 95% CI 1.03-1.19), and high-deductible plans (OR 1.12, 95% CI 1.00-1.26) were more likely to be readmitted within 30 days compared with patients in the capitated health maintenance organization and point-of-service plans. Among privately insured, nonelderly patients, increased patient cost-sharing was associated with lower odds of 7-day and 30-day readmission after abdominal surgery. Insurance arrangements also were significantly associated with postoperative readmissions. Patient cost sharing and insurance arrangements need consideration in the provision of equitable access for quality care. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Influence of municipality-level mean income on access to aortic valve surgery: a cross-sectional observational study under Japan's universal health-care coverage.

    Science.gov (United States)

    Lee, Seitetsu L; Hashimoto, Hideki; Kohro, Takahide; Horiguchi, Hiromasa; Koide, Daisuke; Komuro, Issei; Fushimi, Kiyohide; Yamazaki, Tsutomu; Yasunaga, Hideo

    2014-01-01

    Universal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded. We chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status. We found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69-1.03) or in-hospital mortality (1.00; 0.68-1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34-0.71). Under Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care.

  16. Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures.

    Science.gov (United States)

    Pontis, Alessandro; Sedda, Federica; Mereu, Liliana; Podda, Mauro; Melis, Gian Benedetto; Pisanu, Adolfo; Angioni, Stefano

    2016-09-01

    To critically appraise published randomized controlled trials (RCTs) comparing laparo-endoscopic single site (LESS) and multi-port laparoscopic (MPL) in gynecologic operative surgery; the aim was to assess feasibility, safety, and potential benefits of LESS in comparison to MPL. A systematic review and meta-analysis of eleven RCTs. Women undergoing operative LESS and MPL gynecologic procedure (hysterectomy, cystectomy, salpingectomy, salpingo-oophorectomy, myomectomy). Outcomes evaluated were as follows: postoperative overall morbidity, postoperative pain evaluation at 6, 12, 24 and 48 h, cosmetic patient satisfaction, conversion rate, body mass index (BMI), operative time, blood loss, hemoglobin drop, postoperative hospital stay. Eleven RCTs comprising 956 women with gynecologic surgical disease randomized to either LESS (477) or MPL procedures (479) were analyzed systematically. The LESS approach is a surgical procedure with longer operative and better cosmetic results time than MPL but without statistical significance. Operative outcomes, postoperative recovery, postoperative morbidity and patient satisfaction are similar in LESS and MPL. LESS may be considered an alternative to MPL with comparable feasibility and safety in gynecologic operative procedures. However, it does not offer the expected advantages in terms of postoperative pain and cosmetic satisfaction.

  17. Limited access surgery for 360 degrees in-situ fusion in a dysraphic patient with high-grade spondylolisthesis.

    Science.gov (United States)

    König, M A; Boszczyk, B M

    2012-03-01

    Progressive high-grade spondylolisthesis can lead to spinal imbalance. High-grade spondylolisthesis is often reduced and fused in unbalanced pelvises, whereas in-situ fusion is used more often in balanced patients. The surgical goal is to recreate or maintain sagittal balance but if anatomical reduction is necessary, the risk of nerval damage with nerve root disruption in worst cases is increased. Spinal dysraphism like spina bifida or tethered cord syndrome make it very difficult to achieve reduction and posterior fusion due to altered anatomy putting the focus on anterior column support. Intensive neural structure manipulation should be avoided to reduce neurological complications and re-tethering in these cases. A 26-year-old patient with a history of diastematomyelia, occult spina bifida and tethered cord syndrome presented with new onset of severe low back pain, and bilateral L5/S1 sciatica after a fall. The X-ray demonstrated a grade III spondylolisthesis with spina bifida and the MRI scan revealed bilateral severely narrowed exit foramina L5 due to the listhesis. Because she was well balanced sagittally, the decision for in-situ fusion was made to minimise the risk of neurological disturbance through reduction. Anterior fusion was favoured to minimise manipulation of the dysraphic neural structures. Fusion was achieved via isolated access to the L4/L5 disc space. A L5 transvertebral hollow modular anchorage (HMA) screw was passed into the sacrum from the L4/L5 disc space and interbody fusion of L4/L5 was performed with a cage. The construct was augmented with pedicle screw fixation L4-S1 via a less invasive bilateral muscle split for better anterior biomechanical support. The postoperative course was uneventful and fusion was CT confirmed at the 6-month follow-up. At the last follow-up, she worked full time, was completely pain free and not limited in her free-time activities. The simultaneous presence of high-grade spondylolisthesis and spinal dysraphism

  18. Early Australian experience in robotic sleeve gastrectomy: a single site series.

    Science.gov (United States)

    Silverman, Candice D; Ghusn, Michael A

    2017-05-01

    The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice. © 2016 Royal Australasian College of Surgeons.

  19. Numerical solution of the relativistic single-site scattering problem for the Coulomb and the Mathieu potential

    Science.gov (United States)

    Geilhufe, Matthias; Achilles, Steven; Köbis, Markus Arthur; Arnold, Martin; Mertig, Ingrid; Hergert, Wolfram; Ernst, Arthur

    2015-11-01

    For a reliable fully-relativistic Korringa-Kohn-Rostoker Green function method, an accurate solution of the underlying single-site scattering problem is necessary. We present an extensive discussion on numerical solutions of the related differential equations by means of standard methods for a direct solution and by means of integral equations. Our implementation is tested and exemplarily demonstrated for a spherically symmetric treatment of a Coulomb potential and for a Mathieu potential to cover the full-potential implementation. For the Coulomb potential we include an analytic discussion of the asymptotic behaviour of irregular scattering solutions close to the origin (r\\ll 1 ).

  20. A Single-Site Iron(III-Salan Catalyst for Converting COS to Sulfur-Containing Polymers

    Directory of Open Access Journals (Sweden)

    Ge-Ge Gu

    2017-10-01

    Full Text Available An iron(III complex of tetradentate N,N′-disubstituted bis(aminophenoxide (designated as salan, a saturated version of the corresponding salen ligand with a sterically hindered organic base anchored on the ligand framework, can selectively mediate the conversion of carbonyl sulfide to sulfur-containing polymers by the copolymerization with epoxides. This single-site catalyst exhibits broad substrate scope, and the resultant copolymers have completely alternating structures. In addition, this catalyst is efficient in producing diblock copolymers, suggesting a living polymerization nature.

  1. Screened Coulomb interactions in metallic alloys. II. Screening beyond the single-site and atomic-sphere approximations

    DEFF Research Database (Denmark)

    Ruban, Andrei; Simak, S.I.; Korzhavyi, P.A.

    2002-01-01

    -electron potential and energy. In the case of a random alloy such interactions can be accounted for only by lifting the atomic-sphere and single-site approximations, in order to include the polarization due to local environment effects. Nevertheless, a simple parametrization of the screened Coulomb interactions......A quantitative description of the configurational part of the total energy of metallic alloys with substantial atomic size difference cannot be achieved in the atomic-sphere approximation: It needs to be corrected at least for the multipole-moment interactions in the Madelung part of the one...

  2. Isospecific propylene polymerization with in situ generated bis(phenoxy-amine)zirconium and hafnium single site catalysts.

    Science.gov (United States)

    Makio, Haruyuki; Prasad, Aitha Vishwa; Terao, Hiroshi; Saito, Junji; Fujita, Terunori

    2013-07-07

    Bis(phenoxy-imine) Zr and Hf complexes were activated with (i)Bu3Al or (i)Bu2AlH in conjunction with Ph3CB(C6F5)4 and tested as catalysts for propylene polymerization with emphasis on the enantioselectivity of the isospecific species and the single site polymerization characteristics. The isoselective species was identified as the in situ generated bis(phenoxy-amine) complex whose isoselectivity was sensitive to subtle changes in ligand structure. By employing specific substituents at certain key positions the isotacticity reached an extremely high level comparable to high-end commercial isotactic polypropylenes (Tm > 160 °C). Single site polymerization characteristics depended upon the efficiency and selectivity of the in situ imine reduction which is sensitive to the substituent on the imine nitrogen and the reaction conditions. By using (i)Bu2AlH as a reducing agent, quantitative imine reduction can be achieved with a stoichiometric amount of the reducing agent. This lower alkylaluminum loading is beneficial for the catalyst and significantly enhances the polymerization activity and the molecular weight of the resultant polymer.

  3. Safety and Efficacy of Single-site Phacotrabeculectomy With Mitomicin C Using Nylon and Polyglactin Suture for Scleral Tunnel Closure.

    Science.gov (United States)

    Vijaya, Lingam; David, Rathini L

    2015-01-01

    To evaluate the efficacy of polyglactin use along with nylon suture in scleral tunnel closure after single-site phacotrabeculectomy. This retrospective case series included 139 eyes of 139 patients who had scleral tunnel closure with 1 polyglactin and 1 nylon suture after single-site phacotrabeculectomy with a low dose of mitomycin C between 2002 and 2005. The intraocular pressure (IOP), the visual acuity, the number of glaucoma medications, postoperative complications, and interventions were the outcomes measured. The majority of them had primary open-angle glaucoma (93 eyes, 67%), 93 eyes (67%) had severe glaucomatous optic neuropathy, and 77 eyes (55.3%) had severe visual-field loss. The IOP decreased from a mean preoperative value of 18.1±5.3 mm Hg on a mean number of 1.8±0.8 glaucoma medications to mean IOPs of 13.3±4.6, 14.0±4.3, and 11.8±3.9 mm Hg on a mean number of 0.2±0.6, 0.3±0.7, 0.5±1.0 glaucoma medications (PNylon suturelysis with laser was performed in 16 eyes (11.5%). The technique used here seems to be effective in controlling the IOP and has very minimal associated complications.

  4. Single-Site Active Cobalt-Based Photocatalyst with a Long Carrier Lifetime for Spontaneous Overall Water Splitting.

    Science.gov (United States)

    Liu, Wei; Cao, Linlin; Cheng, Weiren; Cao, Yuanjie; Liu, Xiaokang; Zhang, Wei; Mou, Xiaoli; Jin, Lili; Zheng, Xusheng; Che, Wei; Liu, Qinghua; Yao, Tao; Wei, Shiqiang

    2017-08-01

    An active and stable photocatalyst to directly split water is desirable for solar-energy conversion. However, it is difficult to accomplish overall water splitting without sacrificial electron donors. Herein, we demonstrate a strategy via constructing a single site to simultaneously promote charge separation and catalytic activity for robust overall water splitting. A single Co 1 -P 4 site confined on g-C 3 N 4 nanosheets was prepared by a facile phosphidation method, and identified by electron microscopy and X-ray absorption spectroscopy. This coordinatively unsaturated Co site can effectively suppress charge recombination and prolong carrier lifetime by about 20 times relative to pristine g-C 3 N 4 , and boost water molecular adsorption and activation for oxygen evolution. This single-site photocatalyst exhibits steady and high water splitting activity with H 2 evolution rate up to 410.3 μmol h -1  g -1 , and quantum efficiency as high as 2.2 % at 500 nm. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  5. Five years' experience of transverse groin incision for femoral artery access in arterial reconstructive surgery: parallel observational longitudinal group comparison study.

    LENUS (Irish Health Repository)

    Beirne, Christopher

    2008-07-01

    Vertical groin incisions (VGIs) have been used to access femoral vessels, but reports allude to wound complications. Our aim was to compare VGI with transverse groin incision (TGI) for femoral artery exposure. Over a 5-year interval, 196 patients with 284 femoral artery exposures for supra- and infrainguinal procedures were studied. Primary endpoints were surgical skin site wound infection, seroma, haematoma formation, and major lower limb amputation. Secondary endpoints were graft patency, wound paresthesias, and length of hospital stay. There were 160 TGIs and 124 VGIs. The demographics and risk factor profile were not statistically different between groups. Seroma developed in 4.4% of TGIs and 13.7% of VGIs (p= .005). The complicated skin and soft tissue infection rate was five times greater with VGI (p= .001). The VGI group had a significantly higher rate of major amputation (p= .0005). Significantly higher graft failure rates were observed in the VGI group (p= .011). No paresthesia was reported in any TGI wound. The mean hospital stay was also significantly shorter in the TGI group (p= .006). The study data support and expound on the theory that an alternative incision to VGI offers lower short- and long-term morbidity. Our findings sustain the selection of the TGI in femoral artery surgery for both supra- and infrainguinal procedures without compromise of vessel exposure.

  6. Six-month visual outcomes for the correction of presbyopia using a small-aperture corneal inlay: single-site experience

    Science.gov (United States)

    Moshirfar, Majid; Quist, Tyler S; Skanchy, David F; Wallace, Ryan T; Linn, Steven H; Hoopes, Phillip C

    2016-01-01

    Objective The objective of this study was to describe 6-month postoperative efficacy and safety outcomes after monocular KAMRA corneal inlay implantation in emmetropic presbyopic patients. Study design This study followed a retrospective chart analysis. Setting This study was performed at Hoopes Vision in Draper, UT, USA. Subjects and methods Fifty-seven patients met the inclusion criteria of this study and underwent KAMRA corneal inlay implantation following the approval of the United States Food and Drug Association between May 2015 and April 2016 at a single site. Surgery involved femtosecond laser-created corneal pockets of various depths. Efficacy, safety, and patient satisfaction reports were analyzed at 3 and 6 months. Results At 6 months follow-up, the monocular uncorrected near visual acuity (UNVA) was Jaeger (J) 4 (20/32), the mean uncorrected distance visual acuity was 20/25, and the mean corrected distance visual acuity was 20/20. At 6 months, 71% of patients with a pocket depth of ≥250 μm had a UNVA of 20/20 or better, whereas only 22% of patients with a shallow pocket depth of inlay recentration, all of which resulted in improved visual acuity. At 6 months, 72% of patients reported some level of satisfaction, 26% of patients reported being “not dependent” on reading glasses, and 62% of patients reported being able to do most things in bright light without reading glasses. Conclusion For patients with emmetropic presbyopia, the KAMRA inlay is a viable treatment option resulting in improved UNVA. Increased pocket depth may be associated with better postoperative outcomes. Safety rates are high, while explantation and recentering rates are low. Overall, patient satisfaction of the KAMRA inlay is good. PMID:27843289

  7. Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique.

    Science.gov (United States)

    Moyer, Matthew T; Haluck, Randy S; Gopal, Jegan; Pauli, Eric M; Mathew, Abraham

    2010-07-01

    The self-approximating transluminal access technique (STAT) has been demonstrated to provide safe transluminal access and in-line endoscope positioning to target abdominal organs during natural orifice transluminal endoscopic surgery (NOTES). To date, organ resection with NOTES has typically required percutaneous assistance. We hypothesized that the in-line positioning and partial stability provided by STAT would allow single-access NOTES procedures if a multiarticulated endoscope could be used. Assessment of single-site NOTES, using STAT and a prototype, multi-articulated endoscope. Animal survival study. Penn State Hershey Medical Center Research Laboratories. Thirteen pigs underwent NOTES using a prototype endoscope with 2 articulated channels, a grasping forceps, and an insulated-tip needle-knife. The gallbladder was dissected using a fundus down technique, and hemoclips and a detachable loop were placed on the cystic duct and artery before removal. After a 2- to 3-week observation period, animals were euthanized and necropsy performed. All target organs were successfully resected without laparoscopic assistance. Significant complications were 2 perforations (1 caused by a prototype duodenal occlusion device and 1 caused by enterotomy during cholecystectomy) and 1 entrapment of the small bowel with an endoloop. Postoperatively, all animals gained weight appropriately with 1 killed on postoperative day 12 because of lethargy (cystic duct leak/biloma). This is a limited animal survival study without control arm. The combination of the R-scope and STAT does allow effective, single-site NOTES procedures; however, although the R-scope provides improved tissue manipulation and visibility, the complications incurred here suggest that further improvements in devices and technique will be required for safe and effective single-site NOTES procedures. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  8. Innovations in robotic surgery.

    Science.gov (United States)

    Gettman, Matthew; Rivera, Marcelino

    2016-05-01

    Developments in robotic surgery have continued to advance care throughout the field of urology. The purpose of this review is to evaluate innovations in robotic surgery over the past 18 months. The release of the da Vinci Xi system heralded an improvement on the Si system with improved docking, the ability to further manipulate robotic arms without clashing, and an autofocus universal endoscope. Robotic simulation continues to evolve with improvements in simulation training design to include augmented reality in robotic surgical education. Robotic-assisted laparoendoscopic single-site surgery continues to evolve with improvements on technique that allow for tackling previously complex pathologic surgical anatomy including urologic oncology and reconstruction. Last, innovations of new surgical platforms with robotic systems to improve surgeon ergonomics and efficiency in ureteral and renal surgery are being applied in the clinical setting. Urologic surgery continues to be at the forefront of the revolution of robotic surgery with advancements in not only existing technology but also creation of entirely novel surgical systems.

  9. Wegner estimate and localization for alloy-type models with sign-changing exponentially decaying single-site potentials

    Science.gov (United States)

    Leonhardt, Karsten; Peyerimhoff, Norbert; Tautenhahn, Martin; Veselić, Ivan

    2015-05-01

    We study Schrödinger operators on L2(ℝd) and ℓ2(ℤd) with a random potential of alloy-type. The single-site potential is assumed to be exponentially decaying but not necessarily of fixed sign. In the continuum setting, we require a generalized step-function shape. Wegner estimates are bounds on the average number of eigenvalues in an energy interval of finite box restrictions of these types of operators. In the described situation, a Wegner estimate, which is polynomial in the volume of the box and linear in the size of the energy interval, holds. We apply the established Wegner estimate as an ingredient for a localization proof via multiscale analysis.

  10. Design and Use of Nanostructured Single-Site Heterogeneous Catalysts for the Selective Transformation of Fine Chemicals

    Directory of Open Access Journals (Sweden)

    Vladimiro Dal Santo

    2010-05-01

    Full Text Available Nanostructured single-site heterogeneous catalysts possess the advantages of classical solid catalysts, in terms of easy recovery and recycling, together with a defined tailored chemical and steric environment around the catalytically active metal site. The use of inorganic oxide supports with selected shape and porosity at a nanometric level may have a relevant impact on the regio- and stereochemistry of the catalytic reaction. Analogously, by choosing the optimal preparation techniques to obtain spatially isolated and well-characterised active sites, it is possible to achieve performances that are comparable to (or, in the most favourable cases, better than those obtained with homogeneous systems. Such catalysts are therefore particularly suitable for the transformation of highly-functionalised fine chemicals and some relevant examples where high chemo-, regio- and stereoselectivity are crucial will be described.

  11. Single-Site Active Iron-Based Bifunctional Oxygen Catalyst for a Compressible and Rechargeable Zinc-Air Battery.

    Science.gov (United States)

    Ma, Longtao; Chen, Shengmei; Pei, Zengxia; Huang, Yan; Liang, Guojin; Mo, Funian; Yang, Qi; Su, Jun; Gao, Yihua; Zapien, Juan Antonio; Zhi, Chunyi

    2018-02-27

    The exploitation of a high-efficient, low-cost, and stable non-noble-metal-based catalyst with oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) simultaneously, as air electrode material for a rechargeable zinc-air battery is significantly crucial. Meanwhile, the compressible flexibility of a battery is the prerequisite of wearable or/and portable electronics. Herein, we present a strategy via single-site dispersion of an Fe-N x species on a two-dimensional (2D) highly graphitic porous nitrogen-doped carbon layer to implement superior catalytic activity toward ORR/OER (with a half-wave potential of 0.86 V for ORR and an overpotential of 390 mV at 10 mA·cm -2 for OER) in an alkaline medium. Furthermore, an elastic polyacrylamide hydrogel based electrolyte with the capability to retain great elasticity even under a highly corrosive alkaline environment is utilized to develop a solid-state compressible and rechargeable zinc-air battery. The creatively developed battery has a low charge-discharge voltage gap (0.78 V at 5 mA·cm -2 ) and large power density (118 mW·cm -2 ). It could be compressed up to 54% strain and bent up to 90° without charge/discharge performance and output power degradation. Our results reveal that single-site dispersion of catalytic active sites on a porous support for a bifunctional oxygen catalyst as cathode integrating a specially designed elastic electrolyte is a feasible strategy for fabricating efficient compressible and rechargeable zinc-air batteries, which could enlighten the design and development of other functional electronic devices.

  12. Treatment of hand ischemia following angioaccess surgery using the distal revascularization interval-ligation technique with preservation of vascular access: description of an 18-case series.

    Science.gov (United States)

    Sessa, Carmine; Riehl, Gregory; Porcu, Paolo; Pichot, Olivier; Palacin, Pedro; Maghlaoua, Mohamed; Magne, Jean-Luc

    2004-11-01

    Hand ischemia is a rare complication of angioaccess surgery for hemodialysis. Management usually requires ligation of the arteriovenous fistula (AVF). The purpose of this report is to describe our experience with the use of the distal revascularization interval-ligation (DRIL) technique for treatment of ischemia without ligation of the AVF. From January 1999 to September 2002, the DRIL technique was used to treat 18 patients (10 men, 8 women, 10 diabetic patients) with severe paresthesia of the hand (n = 9) and finger necrosis (n = 10). The AVF was located at the elbow in 16 patients and at the wrist in 2 patients. Mean flow distal to the AVF was less than 10 mL in 5 patients, less than 5 mL in 10, and unmeasurable in 3. The conduit used for all DRIL arterial bypasses, including 15 brachiobrachial bypasses, 1 axillobrachial bypass, 1 brachioradial bypass, and 1 radioradial bypass, was the great saphenous vein graft. Trophic manifestations required finger amputation in five patients, pulpar necrosis resection in four, and transmetacarpal amputation of the index finger in one patient. Symptoms disappeared in 13 patients (73%) and improved in 5 (27%). The time required for healing of finger amputations and trophic manifestations ranged from 15 days to 2 months. Mean arterial flow through the DRIL bypass was 50 mL/min (range, 20-90 mL/min). With a mean follow-up interval of 16 months (range, 5-48 months), primary patency of the DRIL artery bypass and AVF was 94% and the limb salvage rate was 100%. The DRIL technique is the most effective procedure for treatment of angioaccess-induced hand ischemia. This technique can be used to achieve persistent relief of symptoms with continued access patency. The DRIL artery bypass improves vacularization of the hand, and ligature of the artery stops the vascular steal without affecting hemodialysis access. The DRIL technique should be proposed as first-line treatment for hand ischemia due to AVF for hemodialysis.

  13. Robotic surgery

    Science.gov (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  14. Patterns and plasticity in RNA-protein interactions enable recruitment of multiple proteins through a single site

    Science.gov (United States)

    Valley, Cary T.; Porter, Douglas F.; Qiu, Chen; Campbell, Zachary T.; Hall, Traci M. Tanaka; Wickens, Marvin

    2012-01-01

    mRNA control hinges on the specificity and affinity of proteins for their RNA binding sites. Regulatory proteins must bind their own sites and reject even closely related noncognate sites. In the PUF [Pumilio and fem-3 binding factor (FBF)] family of RNA binding proteins, individual proteins discriminate differences in the length and sequence of binding sites, allowing each PUF to bind a distinct battery of mRNAs. Here, we show that despite these differences, the pattern of RNA interactions is conserved among PUF proteins: the two ends of the PUF protein make critical contacts with the two ends of the RNA sites. Despite this conserved “two-handed” pattern of recognition, the RNA sequence is flexible. Among the binding sites of yeast Puf4p, RNA sequence dictates the pattern in which RNA bases are flipped away from the binding surface of the protein. Small differences in RNA sequence allow new modes of control, recruiting Puf5p in addition to Puf4p to a single site. This embedded information adds a new layer of biological meaning to the connections between RNA targets and PUF proteins. PMID:22467831

  15. Highly Stereoselective Heterogeneous Diene Polymerization by Co-MFU-4l: A Single-Site Catalyst Prepared by Cation Exchange.

    Science.gov (United States)

    Dubey, Romain J-C; Comito, Robert J; Wu, Zhenwei; Zhang, Guanghui; Rieth, Adam J; Hendon, Christopher H; Miller, Jeffrey T; Dincă, Mircea

    2017-09-13

    Molecular catalysts offer tremendous advantages for stereoselective polymerization because their activity and selectivity can be optimized and understood mechanistically using the familiar tools of organometallic chemistry. Yet, this exquisite control over selectivity comes at an operational price that is generally not justifiable for the large-scale manufacture of polyfolefins. In this report, we identify Co-MFU-4l, prepared by cation exchange in a metal-organic framework, as a solid catalyst for the polymerization of 1,3-butadiene with high stereoselectivity (>99% 1,4-cis). To our knowledge, this is the highest stereoselectivity achieved with a heterogeneous catalyst for this transformation. The polymer's low polydispersity (PDI ≈ 2) and the catalyst's ready recovery and low leaching indicate that our material is a structurally resilient single-site heterogeneous catalyst. Further characterization of Co-MFU-4l by X-ray absorption spectroscopy provided evidence for discrete, tris-pyrazolylborate-like coordination of Co(II). With this information, we identify a soluble cobalt complex that mimics the structure and reactivity of Co-MFU-4l, thus providing a well-defined platform for studying the catalytic mechanism in the solution phase. This work underscores the capacity for small molecule-like tunability and mechanistic tractability available to transition metal catalysis in metal-organic frameworks.

  16. The role of benzodiazepines in breathlessness: a single site, open label pilot of sustained release morphine together with clonazepam.

    Science.gov (United States)

    Allcroft, Peter; Margitanovic, Vera; Greene, Aine; Agar, Meera R; Clark, Katherine; Abernethy, Amy P; Currow, David C

    2013-07-01

    Breathlessness at rest or on minimal exertion despite optimal treatment of underlying cause(s) is distressing and prevalent. Opioids can reduce the intensity of chronic refractory breathlessness and an anxiolytic may be of benefit. This pilot aimed to determine the safety and feasibility of conducting a phase III study on the intensity of breathlessness by adding regular benzodiazepine to low-dose opioid. This is a single site, open label phase II study of the addition of regular clonazepam 0.5 mg nocte orally to Kapanol(R) 10 mg (sustained release morphine sulphate) orally mane together with docusate/sennosides in people with modified Medical Research Council Scale ≥2. Breathlessness intensity on day four was the efficacy outcome. Participants could extend for another 10 days if they achieved >15% reduction over their own baseline breathlessness intensity. Eleven people had trial medication (eight males, median age 78 years (68 to 89); all had COPD; median Karnofsky 70 (50 to 80); six were on long-term home oxygen. Ten people completed day four. One person withdrew because of unsteadiness on day four. Five participants reached the 15% reduction, but only three went on to the extension study, all completing without toxicity. This study was safe, feasible and there appears to be a group who derive benefits comparable to titrated opioids. Given the widespread use of benzodiazepines for the symptomatic treatment of chronic refractory breathlessness and its poor evidence base, there is justification for a definitive phase III study.

  17. Seasonal variation of heavy metals in ambient air and precipitation at a single site in Washington, DC

    International Nuclear Information System (INIS)

    Melaku, Samuel; Morris, Vernon; Raghavan, Dharmaraj; Hosten, Charles

    2008-01-01

    Atmospheric samples of precipitation and ambient air were collected at a single site in Washington, DC, for 7 months (for ambient air samples) and 1 year (for wet deposition samples) and analyzed for arsenic, cadmium, chromium and lead. The ranges of heavy metal concentrations for 6-day wet deposition samples collected over the 1-year period were 0.20-1.3 μg/l, 0.060-5.1 μg/l, 0.062-4.6 μg/l and 0.11-3.2 μg/l for arsenic, cadmium, chromium and lead, respectively, with a precision better than 5% for more than 95% of the measurements. The ranges of heavy metal concentrations for the 6-day ambient air samples were 0.800-15.7 ng/m 3 , 1.50-30.0 ng/m 3 , 16.8-112 ng/m 3 , and 2.90-137 ng/m 3 for arsenic, cadmium, chromium and lead, respectively, with a precision better than 10%. The spread in the heavy metal concentration over the observation period suggests a high seasonal variability for heavy metal content in both ambient air and wet deposition samples. - High seasonal variability of heavy metals were observed in both ambient air and wet deposition samples

  18. Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study.

    Science.gov (United States)

    Fagotti, Anna; Ghezzi, Fabio; Boruta, David M; Scambia, Giovanni; Escobar, Pedro; Fader, Amanda N; Malzoni, Mario; Fanfani, Francesco

    2014-01-01

    To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Retrospective study (Canadian Task Force classification II-2). Seven institutions in Italy. Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 minutes (range, 149-380 minutes) for LESS-RH, and was 180 minutes (range, 90-240 minutes) for mLPS-RH (p = .001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1 day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p = .03). After a median follow-up of 27 months (range, 9-73 months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy

  19. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 1 (2014) >. Log in or Register to get access to full text downloads.

  20. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 1 (2011) >. Log in or Register to get access to full text downloads.

  1. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 1 (2018) >. Log in or Register to get access to full text downloads.

  2. Cosmetic Surgery

    Science.gov (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  3. Stability of detectability over 17 years at a single site and other lizard detection comparisons from Guam

    Science.gov (United States)

    Rodda, Gordon H.; Dean-Bradley, Kathryn; Campbell, Earl W.; Fritts, Thomas H.; Lardner, Bjorn; Yackel Adams, Amy A.; Reed, Robert N.

    2015-01-01

    To obtain quantitative information about population dynamics from counts of animals, the per capita detectabilities of each species must remain constant over the course of monitoring. We characterized lizard detection constancy for four species over 17 yr from a single site in northern Guam, a relatively benign situation because detection was relatively easy and we were able to hold constant the site, habitat type, species, season, and sampling method. We monitored two species of diurnal terrestrial skinks (Carlia ailanpalai [Curious Skink], Emoia caeruleocauda [Pacific Bluetailed Skink]) using glueboards placed on the ground in the shade for 3 h on rainless mornings, yielding 10,286 skink captures. We additionally monitored two species of nocturnal arboreal geckos (Hemidactylus frenatus [Common House Gecko]; Lepidodactylus lugubris [Mourning Gecko]) on the basis of 15,212 sightings. We compared these count samples to a series of complete censuses we conducted from four or more total removal plots (everything removed to mineral soil) totaling 400 m2(about 1% of study site) in each of the years 1995, 1999, and 2012, providing time-stamped quantification of detectability for each species. Unfortunately, the actual population trajectories taken by the four species were masked by unexplained variation in detectability. This observation of debilitating latent variability in lizard detectability under nearly ideal conditions undercuts our trust in population estimation techniques that fail to quantify venue-specific detectability, rely on pooled detection probability estimates, or assume that modulation in predefined environmental covariates suffices for estimating detectability.

  4. Lability and Basicity of Bipyridine-Carboxylate-Phosphonate Ligand Accelerate Single-Site Water Oxidation by Ruthenium-Based Molecular Catalysts.

    Science.gov (United States)

    Shaffer, David W; Xie, Yan; Szalda, David J; Concepcion, Javier J

    2017-11-01

    A critical step in creating an artificial photosynthesis system for energy storage is designing catalysts that can thrive in an assembled device. Single-site catalysts have an advantage over bimolecular catalysts because they remain effective when immobilized. Hybrid water oxidation catalysts described here, combining the features of single-site bis-phosphonate catalysts and fast bimolecular bis-carboxylate catalysts, have reached turnover frequencies over 100 s -1 , faster than both related catalysts under identical conditions. The new [(bpHc)Ru(L) 2 ] (bpH 2 cH = 2,2'-bipyridine-6-phosphonic acid-6'-carboxylic acid, L = 4-picoline or isoquinoline) catalysts proceed through a single-site water nucleophilic attack pathway. The pendant phosphonate base mediates O-O bond formation via intramolecular atom-proton transfer with a calculated barrier of only 9.1 kcal/mol. Additionally, the labile carboxylate group allows water to bind early in the catalytic cycle, allowing intramolecular proton-coupled electron transfer to lower the potentials for oxidation steps and catalysis. That a single-site catalyst can be this fast lends credence to the possibility that the oxygen evolving complex adopts a similar mechanism.

  5. Lability and Basicity of Bipyridine-Carboxylate-Phosphonate Ligand Accelerate Single-Site Water Oxidation by Ruthenium-Based Molecular Catalysts

    International Nuclear Information System (INIS)

    Shaffer, David W.; Xie, Yan; Szalda, David J.; Concepcion, Javier J.

    2017-01-01

    Here, a critical step in creating an artificial photosynthesis system for energy storage is designing catalysts that can thrive in an assembled device. Single-site catalysts have an advantage over bimolecular catalysts because they remain effective when immobilized. Hybrid water oxidation catalysts described here, combining the features of single-site bis-phosphonate catalysts and fast bimolecular bis-carboxylate catalysts, have reached turnover frequencies over 100 s –1 , faster than both related catalysts under identical conditions. The new [(bpHc)Ru(L) 2 ] (bpH 2 cH = 2,2'-bipyridine-6-phosphonic acid-6'-carboxylic acid, L = 4-picoline or isoquinoline) catalysts proceed through a single-site water nucleophilic attack pathway. The pendant phosphonate base mediates O–O bond formation via intramolecular atom-proton transfer with a calculated barrier of only 9.1 kcal/mol. Additionally, the labile carboxylate group allows water to bind early in the catalytic cycle, allowing intramolecular proton-coupled electron transfer to lower the potentials for oxidation steps and catalysis. That a single-site catalyst can be this fast lends credence to the possibility that the oxygen evolving complex adopts a similar mechanism.

  6. Fixation method does not affect restoration of rotation center in hip replacements: A single-site retrospective study

    OpenAIRE

    Wegner, Alexander; Kauther, Max Daniel; Landgraeber, Stefan; von Knoch, Marius

    2012-01-01

    Abstract Background Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. Methods We retrospectively compared pre- and post-operativ...

  7. South African Journal of Surgery

    African Journals Online (AJOL)

    The South African Journal of Surgery is published by the South African Medical Association and publishes papers related to surgery. Other websites related to this journal: http://www.sajs.org.za/index.php/sajs. Vol 56, No 1 (2018). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT Subscription or Fee Access ...

  8. Maze Surgery

    Science.gov (United States)

    ... Center > Maze Surgery Menu Topics Topics FAQs Maze Surgery Article Info En español Electrical impulses in your ... called an arrhythmia. Why do I need Maze surgery? Maze surgery is also called the Maze procedure. ...

  9. Chapter 12: Surgery for sinonasal disease.

    Science.gov (United States)

    Higgins, Thomas S; Lane, Andrew P

    2013-01-01

    Surgery for chronic rhinosinusitis is an effective complement to a well-designed medical regimen. Functional endoscopic sinus surgery is among the most common surgeries performed for sinonasal disease refractory to maximal medical therapy. Nasal surgery techniques, such as septoplasty and inferior turbinate surgery, may assist in both relieving the symptom of nasal obstruction and providing access for sinus surgery. Although rare, open sinus techniques are occasionally required.

  10. Intraoperative Radiation Using Low-Kilovoltage X-Rays for Early Breast Cancer: A Single Site Trial.

    Science.gov (United States)

    Silverstein, Melvin J; Epstein, Melinda S; Lin, Kevin; Chen, Peter; Khan, Sadia; Snyder, Lincoln; Guerra, Lisa E; De Leon, Cristina; Mackintosh, Ralph; Coleman, Colleen; Lopez, January; Kim, Brian

    2017-10-01

    Two prospective, randomized trials, TARGIT-A and ELIOT, have shown intraoperative radiation therapy (IORT) to be a safe alternative to whole breast radiation therapy following breast-conserving surgery for selected low-risk patients. However, minimal data are available about the clinical effectiveness of this modality of treatment using the Xoft ® Axxent ® Electronic Brachytherapy (eBx ® ) System ® . A total of 201 patients with 204 early-stage breast cancers were enrolled in a prospective X-ray IORT trial from June 2010 to September 2013. All tumors were treated with breast-conserving surgery and IORT. Data were collected at 1 week, 1 month, 6 months, 1 year, and yearly thereafter. With a median follow-up of 50 months, there have been seven ipsilateral breast tumor events (IBTE), no regional or distant recurrences, and no breast cancer-related deaths. One IBTE was within the IORT field, four outside of the IORT field but within the same quadrant as the index cancer, and two were new biologically different cancers in different quadrants. Three events were in patients who deviated from the protocol criteria. Kaplan-Meier analysis projects that 2.9% of patients will recur locally at 4 years. Recurrence rates observed in this trial were comparable to those of the TARGIT-A and ELIOT trials as well as the retrospective TARGIT-R trial. The low complication rates previously reported by our group as well as the low recurrence rates reported in this study support the cautious use and continued study of IORT in selected women with low-risk breast cancer.

  11. Noninvasive monitoring of PaCO2 during one-lung ventilation and minimal access surgery in adults: End-tidal versus transcutaneous techniques

    OpenAIRE

    Cox, Paul; Tobias, Joseph D

    2007-01-01

    Background: Previous studies have suggested that end-tidal CO2 (ET-CO2) may be inaccurate during one-lung ventilation (OLV). This study was performed to compare the accuracy of the noninvasive monitoring of PCO2 using transcutaneous CO2 (TC-CO2) with ET-CO2 in patients undergoing video-assisted thoracoscopic surgery (VATS) during OLV. Materials and Methods: In adult patients undergoing thoracoscopic surgical procedures, PCO2 was simultaneously measured with TC-CO2 and ET-CO2 devices and compa...

  12. Knowledge and Perception of Laparoscopic Surgery among ...

    African Journals Online (AJOL)

    user

    Conclusion: There is a need for public health education in the region to drive this relatively new frontier of surgery to improve our practice and encourage indigenous innovations. INTRODUCTION. Minimal access surgery (Laparoscopic surgery) is prospected as the future of surgery. It offers the benefits of reduced morbidity, ...

  13. Nigerian Journal of Plastic Surgery: Journal Sponsorship

    African Journals Online (AJOL)

    Nigerian Journal of Plastic Surgery: Journal Sponsorship. Journal Home > About the Journal > Nigerian Journal of Plastic Surgery: Journal Sponsorship. Log in or Register to get access to full text downloads.

  14. Estimate of Bariatric Surgery Numbers, 2011-2015

    Science.gov (United States)

    ... to Care Toolkit EHB Access Toolkit Estimate of Bariatric Surgery Numbers, 2011-2016 Published July 2016 2011 2012 ... Search Treat your Obesity | Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  15. Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life.

    Science.gov (United States)

    Immer, Franz F; Moser, Barbara; Krähenbühl, Eva S; Englberger, Lars; Stalder, Mario; Eckstein, Friedrich S; Carrel, Thierry

    2008-05-01

    We have shown that selective antegrade cerebral perfusion improves mid-term quality of life in patients undergoing surgical repair for acute type A aortic dissection and aortic aneurysms. The aim of the study was to assess the impact of continuous cerebral perfusion through the right subclavian artery on immediate outcome and quality of life. Perioperative data of 567 consecutive patients who underwent surgery of the aortic arch using deep hypothermic circulatory arrest have been analyzed. Patients were divided into three groups, according to the management of cerebral protection. Three hundred eighty-seven patients (68.3%) had deep hypothermic circulatory arrest with pharmacologic protection with pentothal only, 91 (16.0%) had selective antegrade cerebral perfusion and pentothal, and 89 (15.7%) had continuous cerebral perfusion through the right subclavian artery and pentothal. All in-hospital data were assessed, and quality of life was analyzed prospectively 2.4 +/- 1.2 years after surgery with the Short Form-36 Health Survey Questionnaire. Major perioperative cerebrovascular injuries were observed in 1.1% of the patients with continuous cerebral perfusion through the right subclavian artery, compared with 9.8% with selective antegrade cerebral perfusion (p life after an arrest time between 30 and 50 minutes with continuous cerebral perfusion through the right subclavian artery was significantly better than selective antegrade cerebral perfusion (90.2 +/- 12.1 versus 74.4 +/- 40.7; p = 0.015). Continuous cerebral perfusion through the right subclavian artery improves considerably perioperative brain protection during deep hypothermic circulatory arrest. Irreversible perioperative neurologic complications can be significantly reduced and duration of deep hypothermic circulatory arrest can be extended up to 50 minutes without impairment in quality of life.

  16. Fixation method does not affect restoration of rotation center in hip replacements: A single-site retrospective study

    Directory of Open Access Journals (Sweden)

    Wegner Alexander

    2012-06-01

    Full Text Available Abstract Background Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. Methods We retrospectively compared pre- and post-operative positions of the hip rotation center in 25 and 68 patients who underwent artificial hip replacements in our department in 2007 using cemented or cementless cup fixation, respectively, with digital radiographic image analysis. Results The mean horizontal and vertical distances between the rotation center and the acetabular teardrop were compared in radiographic images taken pre- and post-operatively. The mean horizontal difference was −2.63 mm (range: -11.00 mm to 10.46 mm, standard deviation 4.23 mm for patients who underwent cementless fixation, and −2.84 mm (range: -10.87 to 5.30 mm, standard deviation 4.59 mm for patients who underwent cemented fixation. The mean vertical difference was 0.60 mm (range: -20.15 mm to 10.00 mm, standard deviation 3.93 mm and 0.41 mm (range: -9.26 mm to 6.54 mm, standard deviation 3.58 mm for the cementless and cemented fixation groups, respectively. The two fixation techniques had no significant difference on the position of the hip rotation center in the 93 patients in this study. Conclusions The hip rotation center was similarly restored using either the cemented or cementless fixation techniques in this patient cohort, indicating that the fixation technique itself does not interfere with the position of the center of rotation. To completely answer this question further studies with more patients are needed.

  17. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  18. Stabilizing Single Sites on Solid Supports: Robust Grafted Ti(IV)-Calixarene Olefin Epoxidation Catalysts via Surface Polymerization and Cross-Linking

    OpenAIRE

    Guo, Yijun; Solovyov, Andrew; Grosso-Giordano, Nicolás A.; Hwang, Son-Jong; Katz, Alexander

    2016-01-01

    This manuscript develops a surface polymerization and cross-linking approach for the stabilization of single-site catalysts on solid surfaces, which is demonstrated here for grafted Ti(IV)-calixarene Lewis acids on silica. Our approach relies on cationic polymerization that is initiated by an adsorbed B(C_6F_5)_3 and uses styrene as the monomer and diisopropenylbenzene as the cross-linking agent. The mildness of this polymerization method is demonstrated by its lack of blocking micropores and...

  19. Cirurgia por orifícios naturais transcolônica: acesso NOTES peri-retal (PNA para excisão mesoretal total Transcolonic natural orifice surgery: peri-rectal NOTES access (PNA for total mesorectal excision

    Directory of Open Access Journals (Sweden)

    Ricardo Zorron

    2010-03-01

    Full Text Available OBJETIVOS: Cirurgia por orifícios naturais tem sido recentemente aplicada em series clínicas para cirurgia abdominal. Apesar de potenciais vantagens do acesso NOTES transcolônico para doenças colorretais, este ainda não havia sido utilizado clinicamente. O presente trabalho descreve a primeira aplicação bem-sucedida de NOTES transcolônico da literatura, em uma nova abordagem de excisão mesoretal total (TME para cancer de reto. MÉTODOS: Foi obtida aprovação de Comitê de Ética em Pesquisa para cirurgias por orifícios naturais, e o paciente assinou termo de consentimento informado. Em um paciente de 54 anos portador de adenocarcinoma de reto, o procedimento de retossigmoidectomia e linfadenectomia, com excisão mesoretal total foi realizada utilizando um acesso posterior transcolônico pouco acima da borda anal. A dissecção mesorretal foi conseguida utilizando um colonoscópio flexível e instrumentos endoscópicos, com assistência laparoscópica. O espécime foi retirado via transanal, e anastomose foi transorificial, com estoma proximal de proteção. RESULTADOS: O tempo operatório foi de 350 min, não ocorrendo complicações operatórias. A evolução pós-operatória foi favorável, e o paciente recebeu alta no sexto dia de pós-operatório com dieta plena. CONCLUSÃO: Este primeiro relato bem sucedido de cirurgia NOTES transcolônica traz potencialmente novas fronteiras de aplicações clínicas na cirurgia minimamente invasiva. O tratamento de doenças colorretais utilizando o novo acesso flexível PNA (Perirectal NOTES Access é uma promissora nova abordagem, paralelamente à laparoscopia e cirurgia aberta, para melhoria do tratamento dos pacientes.OBJECTIVES: Clinical natural orifice surgery has been applied for abdominal surgery in recent years. Despite potential advantages of transcolonic NOTES for colorectal diseases, it was since now not yet clinically applied. The study describes the first successful human

  20. Treatment of supra-alveolar-type defects by a simplified papilla preservation technique for access flap surgery with or without enamel matrix proteins.

    Science.gov (United States)

    Di Tullio, Marcella; Femminella, Beatrice; Pilloni, Andrea; Romano, Luigi; D'Arcangelo, Camillo; De Ninis, Paolo; Paolantonio, Michele

    2013-08-01

    In this study, we compare the effectiveness of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) technique to SPPF alone when surgically treating supra-alveolar-type defects. Fifty patients, from 54 initially selected, presenting horizontal bone loss around ≥4 adjacent teeth, were treated by an SPPF technique; 25 participants also received EMD (test group) and 25 patients underwent flap surgery alone (control group). A complete clinical and radiographic examination was performed at baseline and 12 months after treatment. Pre- and post-therapy probing depth (PD), clinical attachment level (CAL), gingival recession (GR), and radiographic bone level (BL) were compared between treatments. After 12 months, PD, CAL, and GR in both groups showed significant differences from baseline (P <0.001). No differences in BL scores were observed within the groups at the 12-month examination. After 1 year, the test group showed significantly (P <0.001) greater PD reduction (3.4 ± 0.7 mm) and CAL gain (2.8 ± 0.8 mm) and a smaller GR increase (0.6 ± 0.4 mm) compared to the control group (PD, 2.2 ± 0.8 mm; CAL, 1.0 ± 0.6 mm; GR, 1.2 ± 0.7 mm.) BL changes did not significantly differ between the experimental groups. The results of this study suggest that combining EMD and SPPF in the treatment of suprabony defects may lead to a greater clinical improvement compared to SPPF alone.

  1. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce.

    Science.gov (United States)

    Harries, Rhiannon L; Gokani, Vimal J; Smitham, Peter; Fitzgerald, J Edward F

    2016-04-18

    Generational changes in lifestyle expectations, working environments and the feminisation of the medical workforce have seen an increased demand in postgraduate less than full-time training (LTFT). Despite this, concerns remain regarding access to, and information about, flexible training for surgeons. This study aimed to assess the opinions and experiences of LTFT for surgical trainees. Prospective, questionnaire-based cross-sectional study. An electronic, self-administered questionnaire was distributed in the UK and Republic of Ireland through mailing lists via the Association of Surgeons in Training and British Orthopedic Trainee Association. Overall, 876 completed responses were received, representing all grades of trainee across all 10 surgical specialties. Median age was 33 years and 63.4% were female. Of those who had undertaken LTFT, 92.5% (148/160) were female. Most worked 60% of a full-time post (86/160, 53.8%). The reasons for either choosing or considering LTFT were childrearing (82.7%), caring for a dependent (12.6%) and sporting commitments (6.8%). Males were less likely to list childrearing than females (64.9% vs 87.6%; p<0.0001). Only 38% (60/160) found the application process easy and 53.8% (86/160) experienced undermining behaviour from workplace staff as a result of undertaking LTFT. Of all respondents, an additional 53.7% (385/716) would consider LTFT in future; 27.5% of which were male (106/385). Overall, only 9.9% of all respondents rated current LTFT information as adequate. Common sources of information were other trainees (47.3%), educational supervisors (20.6%) and local postgraduate school website (19.5%). Over half of surgical trainees working LTFT have experienced undermining behaviour as a result of their LTFT. Despite a reported need for LTFT in both genders, this remains difficult to organise, access to useful information is poor and negative attitudes among staff remain. Recommendations are made to provide improved support and

  2. Clinical trials in Surgery | Mwachaka | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 11, No 2 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Clinical trials in Surgery. P Mwachaka, JWM Kigera. Abstract.

  3. Archives: Nigerian Journal of Surgery

    African Journals Online (AJOL)

    Items 1 - 16 of 16 ... Archives: Nigerian Journal of Surgery. Journal Home > Archives: Nigerian Journal of Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 16 of 16 Items ...

  4. Archives: Annals of African Surgery

    African Journals Online (AJOL)

    Items 1 - 19 of 19 ... Archives: Annals of African Surgery. Journal Home > Archives: Annals of African Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 19 of 19 Items. 2017 ...

  5. Archives: Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Items 1 - 32 of 32 ... Archives: Annals of Pediatric Surgery. Journal Home > Archives: Annals of Pediatric Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 32 of 32 Items ...

  6. Plastic Surgery: Tackling Misconceptions

    African Journals Online (AJOL)

    will succeed. First impressions tend to last, and if young people's first impression of plastic surgeons is that they spend much of their time doing cosmetic surgery then this is a first impression that might be long ... Res 2014;4 Suppl S3:169‑70. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI:.

  7. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  10. O-O bond formation in ruthenium-catalyzed water oxidation: single-site nucleophilic attack vs. O-O radical coupling.

    Science.gov (United States)

    Shaffer, David W; Xie, Yan; Concepcion, Javier J

    2017-10-16

    In this review we discuss at the mechanistic level the different steps involved in water oxidation catalysis with ruthenium-based molecular catalysts. We have chosen to focus on ruthenium-based catalysts to provide a more coherent discussion and because of the availability of detailed mechanistic studies for these systems but many of the aspects presented in this review are applicable to other systems as well. The water oxidation cycle has been divided in four major steps: water oxidative activation, O-O bond formation, oxidative activation of peroxide intermediates, and O 2 evolution. A significant portion of the review is dedicated to the O-O bond formation step as the key step in water oxidation catalysis. The two main pathways to accomplish this step, single-site water nucleophilic attack and O-O radical coupling, are discussed in detail and compared in terms of their potential use in photoelectrochemical cells for solar fuels generation.

  11. Redox-active on-surface polymerization of single-site divalent cations from pure metals by a ketone-functionalized phenanthroline

    Energy Technology Data Exchange (ETDEWEB)

    Skomski, Daniel; Tempas, Christopher D.; Bukowski, Gregory S.; Smith, Kevin A.; Tait, Steven L., E-mail: tait@indiana.edu [Department of Chemistry, Indiana University, 800 E. Kirkwood Ave., Bloomington, Indiana 47405 (United States)

    2015-03-14

    Metallic iron, chromium, or platinum mixing with a ketone-functionalized phenanthroline ligand on a single crystal gold surface demonstrates redox activity to a well-defined oxidation state and assembly into thermally stable, one dimensional, polymeric chains. The diverging ligand geometry incorporates redox-active sub-units and bi-dentate binding sites. The gold surface provides a stable adsorption environment and directs growth of the polymeric chains, but is inert with regard to the redox chemistry. These systems are characterized by scanning tunnelling microscopy, non-contact atomic force microscopy, and X-ray photoelectron spectroscopy under ultra-high vacuum conditions. The relative propensity of the metals to interact with the ketone group is examined, and it is found that Fe and Cr more readily complex the ligand than Pt. The formation and stabilization of well-defined transition metal single-sites at surfaces may open new routes to achieve higher selectivity in heterogeneous catalysts.

  12. Hemorrhoid surgery

    Science.gov (United States)

    ... surgery. Hemorrhoid surgery may involve: Putting a small rubber band around a hemorrhoid to shrink it by blocking blood flow. Stapling a hemorrhoid to block blood flow, causing it to shrink. Using a ...

  13. Plastic Surgery

    Science.gov (United States)

    ... idea for teens? As with everything, there are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board-certified plastic surgeons spend a lot of time ... the right reasons. Many plastic surgery procedures are just that — ...

  14. Broadband Access

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Broadband Access. Worldwide market for broadband access $30 Billion! Over 200 million broadband subscribers worldwide! Various Competing Broadband access. Digital Subscriber line; Wireless; Optical Fiber.

  15. Tuning the properties of metal–organic framework nodes as supports of single-site iridium catalysts: node modification by atomic layer deposition of aluminium

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong [Department of Chemical Engineering; University of California; Davis; USA; Momeni, Mohammad R. [Department of Chemistry; Chemical Theory Center; Supercomputing Institute; University of Minnesota; Minneapolis; Demir, Hakan [Department of Chemistry; Chemical Theory Center; Supercomputing Institute; University of Minnesota; Minneapolis; Pahls, Dale R. [Department of Chemistry; Chemical Theory Center; Supercomputing Institute; University of Minnesota; Minneapolis; Rimoldi, Martino [Department of Chemistry; Northwestern University; Evanston; USA; Wang, Timothy C. [Department of Chemistry; Northwestern University; Evanston; USA; Farha, Omar K. [Department of Chemistry; Northwestern University; Evanston; USA; Department of Chemistry; Hupp, Joseph T. [Department of Chemistry; Northwestern University; Evanston; USA; Cramer, Christopher J. [Department of Chemistry; Chemical Theory Center; Supercomputing Institute; University of Minnesota; Minneapolis; Gates, Bruce C. [Department of Chemical Engineering; University of California; Davis; USA; Gagliardi, Laura [Department of Chemistry; Chemical Theory Center; Supercomputing Institute; University of Minnesota; Minneapolis

    2017-01-01

    The metal–organic framework NU-1000, with Zr6-oxo, hydroxo, and aqua nodes, was modified by incorporation of hydroxylated Al(iii) ions by ALD-like chemistry with [Al(CH3)2(iso-propoxide)]2followed by steam (ALD = atomic layer deposition). Al ions were installed to the extent of approximately 7 per node. Single-site iridium diethylene complexes were anchored to the nodes of the modified and unmodified MOFs by reaction with Ir(C2H4)2(acac) (acac = acetylacetonate) and converted to Ir(CO)2complexes by treatment with CO. Infrared spectra of these supported complexes show that incorporation of Al weakened the electron donor tendency of the MOF. Correspondingly, the catalytic activity of the initial supported iridium complexes for ethylene hydrogenation increased, as did the selectivity for ethylene dimerization. The results of density functional theory calculations with a simplified model of the nodes incorporating Al(iii) ions are in qualitative agreement with some catalyst performance data.

  16. Outcome of patients undergoing open heart surgery at the Uganda ...

    African Journals Online (AJOL)

    governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally. Keywords: Open heart surgery, ... where surgery is the definitive therapy were operated. The mean age of the patients .... plasma and vitamin K. She remained ventilator depend- ent from initial surgery.

  17. Evaluation of a digital drainage system (Thopaz) in over 250 cases at a single site: A retrospective case-control study.

    Science.gov (United States)

    Arai, Hiromasa; Tajiri, Michihiko; Kameda, Yohei; Shiino, Kimihisa; Ando, Kohei; Okudela, Koji; Masuda, Munetaka

    2018-04-01

    The aim of this study was to evaluate the efficacy of the Thopaz system, a new drainage system in management of general thoracic surgery, based on a review of our clinical practice and a comparison of the utility of the Thopaz device compared with a standard drainage system. A review of 540 thoracic surgeries at our hospital was performed. These cases were divided into 275 treated with the Thopaz system from April 2014 to March 2015 and 265 treated with a standard system from April 2013 to March 2014. The characteristics of patients and outcomes after surgery were compared in these 2 groups. The characteristics of the patients were similar in the 2 groups. Outcomes after surgery, including types of operation, period of chest tube placement, chest tube reinsertion rate and clamping test rate also did not differ significantly between the groups. The non-inferiority of the Thopaz system compared to a standard system was verified statistically. With advantages of providing objective data as a small portable system, in addition to the quietness of the unit and the ease of setup and operation, Thopaz system is likely to become mainstream in postoperative management in general thoracic surgery. © 2017 John Wiley & Sons Ltd.

  18. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson

    2008-11-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  19. Archives: East and Central African Journal of Surgery

    African Journals Online (AJOL)

    Items 1 - 40 of 40 ... Archives: East and Central African Journal of Surgery. Journal Home > Archives: East and Central African Journal of Surgery. Log in or Register to get access to full text downloads.

  20. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    3 Department of Paediatric Surgery, Sophia's Children Hospital/Erasmus Medical Centre, Rotterdam, The Netherlands. 4 Department of Paediatric Surgery, Emma's Children Hospital/Academic Medical Centre, Amsterdam, The Netherlands. 5 Department of Radiology, Red Cross War Memorial Children's Hospital, ...

  1. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    Gastroschisis in a developing country: poor resuscitation is a more significant predictor of mortality than postnatal transfer time. PAEDIATRIC SURGERY. P Stevens,1 E Muller,1 P Becker2. 1 Department of Paediatric Surgery, Steve Biko Academic Hospital, University of Pretoria. 2 South African Medical Research Council.

  2. Robotic surgery in gynecology.

    Science.gov (United States)

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.

  3. An evaluation of single-site statistical downscaling techniques in terms of indices of climate extremes for the Midwest of Iran

    Science.gov (United States)

    Farajzadeh, M.; Oji, R.; Cannon, A. J.; Ghavidel, Y.; Massah Bavani, A.

    2015-04-01

    Seven single-site statistical downscaling methods for daily temperature and precipitation, including four deterministic algorithms [analog model (ANM), quantile mapping with delta method extrapolation (QMD), cumulative distribution function transform (CDFt), and model-based recursive partitioning (MOB)] and three stochastic algorithms [generalized linear model (GLM), Conditional Density Estimation Network Creation and Evaluation (CaDENCE), and Statistical Downscaling Model-Decision Centric (SDSM-DC] are evaluated at nine stations located in the mountainous region of Iran's Midwest. The methods are of widely varying complexity, with input requirements that range from single-point predictors of temperature and precipitation to multivariate synoptic-scale fields. The period 1981-2000 is used for model calibration and 2001-2010 for validation, with performance assessed in terms of 27 Climate Extremes Indices (CLIMDEX). The sensitivity of the methods to large-scale anomalies and their ability to replicate the observed data distribution in the validation period are separately tested for each index by Pearson correlation and Kolmogorov-Smirnov (KS) tests, respectively. Combined tests are used to assess overall model performances. MOB performed best, passing 14.5 % (49.6 %) of the combined (single) tests, respectively, followed by SDSM, CaDENCE, and GLM [14.5 % (46.5 %), 13.2 % (47.1 %), and 12.8 % (43.2 %), respectively], and then by QMD, CDFt, and ANM [7 % (45.7 %), 4.9 % (45.3 %), and 1.6 % (37.9 %), respectively]. Correlation tests were passed less frequently than KS tests. All methods downscaled temperature indices better than precipitation indices. Some indices, notably R20, R25, SDII, CWD, and TNx, were not successfully simulated by any of the methods. Model performance varied widely across the study region.

  4. Single-site laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural and spinal needle: excellent results in 1464 children with inguinal hernia/hydrocele.

    Science.gov (United States)

    Wang, Furan; Zhong, Hongji; Chen, Yi; Zhao, Junfeng; Li, Yan; Chen, Junxian; Dong, Sheng

    2017-07-01

    Laparoscopic percutaneous extraperitoneal closure (LPEC) of the internal ring is a well-developed procedure for pediatric inguinal hernia and hydrocele. To reduce the skin incisions and improve the cosmesis, single-site LPEC (SLPEC) has been developed with numerous techniques and instruments. In this study, we described our modifications of SLPEC using an epidural and spinal needle in a large pediatric population. From February 2013 to February 2016, 1464 pediatric patients who underwent SLPEC in our hospital were retrospectively reviewed. A 5-mm laparoscope was introduced at the subumbilicus. An 18-gauge epidural needle with a silk suture loop was introduced into the corresponding skin of the internal ring. The needle was advanced extraperitoneally on the medial side of the ring. The suture loop was pushed into peritoneal cavity by the spinal needle. The epidural needle was withdrawn to the roof of the internal ring and then kept advancing along the lateral side. Aided by the spinal needle and laparoscope, a long suture loop was sent into the first loop in peritoneal cavity. The long suture loop was pulled out of the abdominal wall by picking up the first loop, and the internal ring was closed by knotting the suture extracorporeally. The contralateral patent processus vaginalis (CPPV) was simultaneously repaired if present. In total, 981 patients presented with inguinal hernia and 483 with hydrocele. A CPPV was present in 483 patients with unilateral pathology and thus simultaneously repaired. The hydrodissection technique and grasping forceps were used in 290 and 113 patients, respectively. The median operation time was 11 min (7-18 min) and 18 min (10-30 min) for unilateral and bilateral inguinal hernias/hydroceles, respectively. There was no development of intra- or postoperative complications. SLPEC using an epidural and spinal needle can be performed with excellent results in pediatric inguinal hernias and hydroceles.

  5. Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum

    Directory of Open Access Journals (Sweden)

    Nan Song

    2013-02-01

    of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.

  6. Wireless Access

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Wireless Access. Wireless connect to the Base station. Easy and Convenient access. Costlier as compared to the wired technology. Reliability challenges. We see it as a complementary technology to the DSL.

  7. Smartphones in Surgery

    Directory of Open Access Journals (Sweden)

    Ara A. Salibian

    2011-01-01

    Full Text Available Smartphones have the capability of enhancing many aspects of the continuum of surgical care by providing an efficient means of multimedia communication among surgeons and healthcare personnel. The ability for mobile Internet and email access, along with features such as built-in cameras and video calling, allow surgeons to rapidly access, send and receive patient information without being restricted by issues of connectivity. Smartphones create an unrestricted network of data sharing, improving the flexibility of patient consultation, timeliness of preoperative preparation, efficiency of post-operative care and the effectiveness of a surgical team. Furthermore, smartphones provide mobile access to a multitude of surgical resources to bolster continued surgical education. This article presents a review of the current literature on the utilizations of smartphones in surgery, discusses their benefits and limitations, and addresses the possibility of incorporating smartphones into the protocol of surgical care.

  8. Rodding Surgery

    Science.gov (United States)

    ... usually undertaken as a scheduled elective procedure. An optimal age for a first rodding surgery has not ... which may prevent or postpone the need for replacement. The smallest diameter expanding rods are still too ...

  9. Lung surgery

    Science.gov (United States)

    ... the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to ... Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed ...

  10. Bariatric Surgery

    Science.gov (United States)

    ... action of certain hormones, such as ghrelin —“the hunger hormone.” People have these types of surgery if ... organizations to further patient education on hormone related issues. Network Sponsors The Hormone Health Network is supported ...

  11. Epilepsy Surgery

    Science.gov (United States)

    ... and the portion of your brain that's involved: Memory problems. The temporal lobe handles memory and language functions, so surgery on this part ... computerized tomography (SPECT). The scan image varies in color depending on the amount of blood flow in ...

  12. After Surgery

    Science.gov (United States)

    After any operation, you'll have some side effects. There is usually some pain with surgery. There ... anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions. ...

  13. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Barnett J, Mohanty A, Desai SK, Patterson JT. Neurosurgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, ...

  14. A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele.

    Science.gov (United States)

    Chen, Yi; Wang, Furan; Zhong, Hongji; Zhao, Junfeng; Li, Yan; Shi, Zhan

    2017-12-01

    Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports. A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0. 49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73-43.0%). The average of mean operative time was 19.56 min (range 8.30-41.19 min) for unilateral SLPEC and 27.23 min (range 12.80-48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0-3.24%), 0.05% (range 0-0.89%), 0.70% (range 0-15.5%), 0.23% (range 0-3.57%), 0.33% (range 0-3.33%), 0.05% (range 0-4.55%), and 0.03% (range 0-1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures. SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid

  15. Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Zheng Zhang

    2017-01-01

    Full Text Available The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT. The odds ratio (OR or standardized mean difference (SMD and their 95% confidence intervals (95% CIs were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = −1.454, 95% CI: −2.502-−0.405, P = 0.007; non-RCT: SMD = −2.906, 95% CI: −3.796-−2.017, P = 0.000; and RCT: SMD = −0.841, 95% CI: −1.393-−0.289, P = 0.003 and less pain experience at 3 h or 6 h (SMD = −0.447, 95% CI: −0.754-−0.139, P = 0.004, day 1 (SMD = −0.477, 95% CI: −0.905-−0.05, P = 0.029, and day 2 (SMD = −0.612, 95% CI: −1.099-−0.125, P = 0.014 postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief, and complications (hydrocele and recurrence yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.

  16. Bariatric surgery

    Science.gov (United States)

    Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.

    2010-01-01

    Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ...

  18. Editorial: Teaching Professionalism in Surgery and Beyond ...

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 1 (2017) >. Log in or Register to get access to full text downloads.

  19. Cosmetic Surgery: What to Know Beforehand

    Science.gov (United States)

    ... follow-up care or additional corrective procedures. Risks. Dissatisfaction is possible after any type of cosmetic surgery. ... www.plasticsurgery.org/articles-and-galleries/patient-and-consumer-information/patient-safety.html?sub=Accredited%20facilities. Accessed ...

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  1. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  2. Open Access

    Science.gov (United States)

    Suber, Peter

    2012-01-01

    The Internet lets us share perfect copies of our work with a worldwide audience at virtually no cost. We take advantage of this revolutionary opportunity when we make our work "open access": digital, online, free of charge, and free of most copyright and licensing restrictions. Open access is made possible by the Internet and copyright-holder…

  3. Bariatric surgery

    Directory of Open Access Journals (Sweden)

    Alojz Pleskovič

    2013-07-01

    Full Text Available Background: In almost six decades different surgical techniques have been developed to treat patients with morbid obesity. Various surgical techniques are generally divided with respect to their effect into restrictive, malabsorbtive and humoral and a combination of these. Surgically modified human metabolism ameliorates metabolic diseases, particularly diabetes, even in nonobese patients. The understanding of metabolic effects changed the traditional paradigm of bariatric surgery from simple weight-loss procedure to metabolic surgery affecting whole-body metabolism. Proper surgical technique for individual patient is the most important factor influencing long- term results, comorbidities and quality of life. Recommendations for patient selection, surgical methods and pre- and postoperative patient management are to be respected. Metabolic surgery principles and current concepts are presented.

  4. Evaluating the Effectiveness of an Antimicrobial Stewardship Program on Reducing the Incidence Rate of Healthcare-Associated Clostridium difficile Infection: A Non-Randomized, Stepped Wedge, Single-Site, Observational Study.

    Directory of Open Access Journals (Sweden)

    Giulio DiDiodato

    Full Text Available The incidence rate of healthcare-associated Clostridium difficile infection (HA-CDI is estimated at 1 in 100 patients. Antibiotic exposure is the most consistently reported risk factor for HA-CDI. Strategies to reduce the risk of HA-CDI have focused on reducing antibiotic utilization. Prospective audit and feedback is a commonly used antimicrobial stewardship intervention (ASi. The impact of this ASi on risk of HA-CDI is equivocal. This study examines the effectiveness of a prospective audit and feedback ASi on reducing the risk of HA-CDI.Single-site, 339 bed community-hospital in Barrie, Ontario, Canada. Primary outcome is HA-CDI incidence rate. Daily prospective and audit ASi is the exposure variable. ASi implemented across 6 wards in a non-randomized, stepped wedge design. Criteria for ASi; any intravenous antibiotic use for ≥ 48 hrs, any oral fluoroquinolone or oral second generation cephalosporin use for ≥ 48 hrs, or any antimicrobial use for ≥ 5 days. HA-CDI cases and model covariates were aggregated by ward, year and month starting September 2008 and ending February 2016. Multi-level mixed effect negative binomial regression analysis was used to model the primary outcome, with intercept and slope coefficients for ward-level random effects estimated. Other covariates tested for inclusion in the final model were derived from previously published risk factors. Deviance residuals were used to assess the model's goodness-of-fit.The dataset included 486 observation periods, of which 350 were control periods and 136 were intervention periods. After accounting for all other model covariates, the estimated overall ASi incidence rate ratio (IRR was 0.48 (95% 0.30, 0.79. The ASi effect was independent of antimicrobial utilization. The ASi did not seem to reduce the risk of Clostridium difficile infection on the surgery wards (IRR 0.87, 95% CI 0.45, 1.69 compared to the medicine wards (IRR 0.42, 95% CI 0.28, 0.63. The ward-level burden of

  5. Cosmetic surgery.

    OpenAIRE

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks.

  6. PLASTIC SURGERY

    African Journals Online (AJOL)

    surgery or subcutaneous mastectomy utilizing a periareolar or circumareolar ... old. Informed consent was obtained. The height of the patients was measured from heel to vertex with a standard height measuring device. The chest circumference was ... The procedure was followed with liposuction 3-6 months later if required.

  7. GENERAL SURGERY

    African Journals Online (AJOL)

    Summary: The multidisciplinary management of Breast Cancer (BC) has evolved over the past 50 years: the patient is offered a choice of .... Choice of procedure. – For women with early BC, there is essentially a choice between 2 procedures: mastectomy or breast conserving surgery with radiation (BCT). The standard.

  8. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  9. GENERAL SURGERY

    African Journals Online (AJOL)

    We plan to protocolise earlier surgery and blood conservation strategies intraoperatively in addition to a restrictive strategy in ..... Marshall JC. Review Transfusion trigger: when to transfuse? Crit Care. 2004;8(Suppl 2):S31-3. 11. Hofmann A, Farmer S, Towler SC. Strategies to preempt and reduce the use of blood products: ...

  10. Cosmetic Surgery

    Science.gov (United States)

    ... http://www.mayoclinic.com/health/cosmetic-surgery/SN00006 Medical Tourism (Copyright © American Society of Plastic Surgeons) — People considering ... in exotic vacation spots. This publication talks about "medical tourism" and whether it's safe. http://www.plasticsurgery.org/ ...

  11. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  12. GENERAL SURGERY

    African Journals Online (AJOL)

    after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113(2):188-193. http:// dx.doi.org/10.1002/jso.24125. 2. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): An international study group of pancreatic surgery (ISGPS) definition. Surg. 2007;142(1):20-25. http://.

  13. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity...

  14. TRAUMA SURGERY

    African Journals Online (AJOL)

    deaths due to other trauma types (gunshot wounds, road traffic fatalities and assault) ... the axillary artery was ligated during surgery. Type of ... Left axillary artery. Ischaemic left upper limb. 3. Fifth intercostal space on the left. Bilateral pneumothorax and haemothorax still present at autopsy. (intercostal drain only inserted on ...

  15. Manual Control for Medical Instruments in Minimally Invasive Surgery

    NARCIS (Netherlands)

    Fan, C.

    2014-01-01

    With the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal invasive surgery. During such procedures, surgeons have to manoeuver the instruments from outside the patient while looking at the monitor. Long and

  16. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  17. Accessing memory

    Science.gov (United States)

    Yoon, Doe Hyun; Muralimanohar, Naveen; Chang, Jichuan; Ranganthan, Parthasarathy

    2017-09-26

    A disclosed example method involves performing simultaneous data accesses on at least first and second independently selectable logical sub-ranks to access first data via a wide internal data bus in a memory device. The memory device includes a translation buffer chip, memory chips in independently selectable logical sub-ranks, a narrow external data bus to connect the translation buffer chip to a memory controller, and the wide internal data bus between the translation buffer chip and the memory chips. A data access is performed on only the first independently selectable logical sub-rank to access second data via the wide internal data bus. The example method also involves locating a first portion of the first data, a second portion of the first data, and the second data on the narrow external data bus during separate data transfers.

  18. Records of shallow-water marine invertebrates from French Frigate Shoals, Northwestern Hawaiian Islands with a note on nonindigenous species from NOWRAMP 2000 surveys at 39 sites and a 2002-03 survey at a single site (NODC Accession 0001083)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In September of 2000, the Northwest Hawaiian Islands Rapid Assessment and Monitoring Program (NOW-RAMP) Expedition surveyed French Frigate Shoals (FFS) and a number...

  19. Surgical Adhesives in Facial Plastic Surgery.

    Science.gov (United States)

    Toriumi, Dean M; Chung, Victor K; Cappelle, Quintin M

    2016-06-01

    In facial plastic surgery, attaining hemostasis may require adjuncts to traditional surgical techniques. Fibrin tissue adhesives have broad applications in surgery and are particularly useful when addressing the soft tissue encountered in facial plastic surgery. Beyond hemostasis, tissue adhesion and enhanced wound healing are reported benefits associated with a decrease in operating time, necessity for drains and pressure dressings, and incidence of wound healing complications. These products are clinically accessible to most physicians who perform facial plastic surgery, including skin grafts, flaps, rhytidectomy, and endoscopic forehead lift. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ...

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  2. Tennis elbow surgery - discharge

    Science.gov (United States)

    Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Soon after surgery, severe pain will decrease, but you may have mild soreness for 3 to 6 months.

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...

  4. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were......The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... to sex, age, and somatosensory change. High satisfaction and improvement in facial esthetic after OS were seen. Young patients (16-25 years) and men indicated a higher degree of satisfaction than old (>25 years) patients and women. The use of social media seems to be an interesting platform...

  5. Accessible Knowledge - Knowledge on Accessibility

    DEFF Research Database (Denmark)

    Kirkeby, Inge Mette

    2015-01-01

    Although serious efforts are made internationally and nationally, it is a slow process to make our physical environment accessible. In the actual design process, architects play a major role. But what kinds of knowledge, including research-based knowledge, do practicing architects make use of when...... designing accessible environments? The answer to the question is crucially important since it affects how knowledge is distributed and how accessibility can be ensured. In order to get first-hand knowledge about the design process and the sources from which they gain knowledge, 11 qualitative interviews...... were conducted with architects with experience of designing for accessibility. The analysis draws on two theoretical distinctions. The first is research-based knowledge versus knowledge used by architects. The second is context-independent knowledge versus context-dependent knowledge. The practitioners...

  6. Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial.

    Science.gov (United States)

    Grochola, Lukasz Filip; Soll, Christopher; Zehnder, Adrian; Wyss, Roland; Herzog, Pascal; Breitenstein, Stefan

    2017-02-09

    Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site™ platform for cholecystectomy is safe, feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy. Moreover, the robot-assisted technology has been shown to reduce the surgeon's stress load compared to standard single-incision laparoscopy in an experimental setup, suggesting an important advantage of the da Vinci platform. However, the above-mentioned observations are based solely on case series, case reports and experimental data, as high-quality clinical trials to demonstrate the benefits of the da Vinci Single-Site™ cholecystectomy have not been performed to date. This study addresses the question whether robot-assisted Single-Site™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon's stress load, while matching the standards of the conventional single-incision approach with regard to peri- and postoperative outcomes. It is designed as a single centre, single-blinded randomized controlled trial, which compares both surgical approaches with the primary endpoint surgeon's physical and mental stress load at the time of surgery. In addition, the study aims to assess secondary endpoints such as operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, costs of procedure, health-related quality of life, cosmesis and complications. Patients as well as ward staff are blinded until the 1 st postoperative year. Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon's comfort of 0.8 (power of 0.8, alpha-error level of 0.05, error margin of 10-15%) resulted in a number of 30 randomized patients per arm. The study is the first randomized controlled trial that compares the da Vinci Single Site™ platform to

  7. Open access

    CERN Document Server

    Suber, Peter

    2012-01-01

    The Internet lets us share perfect copies of our work with a worldwide audience at virtually no cost. We take advantage of this revolutionary opportunity when we make our work "open access": digital, online, free of charge, and free of most copyright and licensing restrictions. Open access is made possible by the Internet and copyright-holder consent, and many authors, musicians, filmmakers, and other creators who depend on royalties are understandably unwilling to give their consent. But for 350 years, scholars have written peer-reviewed journal articles for impact, not for money, and are free to consent to open access without losing revenue. In this concise introduction, Peter Suber tells us what open access is and isn't, how it benefits authors and readers of research, how we pay for it, how it avoids copyright problems, how it has moved from the periphery to the mainstream, and what its future may hold. Distilling a decade of Suber's influential writing and thinking about open access, this is the indispe...

  8. Access French

    CERN Document Server

    Grosz, Bernard

    2014-01-01

    Access is the major new language series designed with the needs of today's generation of students firmly in mind. Whether learning for leisure or business purposes or working towards a curriculum qualification, Access French is specially designed for adults of all ages and gives students a thorough grounding in all the skills required to understand, speak, read and write contemporary French from scratch. The coursebook consists of 10 units covering different topic areas, each of which includes Language Focus panels explaining the structures covered and a comprehensive glossary. Learning tips

  9. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...... to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients....

  10. Conversion of a beta-strand to an alpha-helix induced by a single-site mutation observed in the crystal structure of Fis mutant Pro26Ala.

    OpenAIRE

    Yang, W. Z.; Ko, T. P.; Corselli, L.; Johnson, R. C.; Yuan, H. S.

    1998-01-01

    The conversion from an alpha-helix to a beta-strand has received extensive attention since this structural change may induce many amyloidogenic proteins to self-assemble into fibrils and cause fatal diseases. Here we report the conversion of a peptide segment from a beta-strand to an alpha-helix by a single-site mutation as observed in the crystal structure of Fis mutant Pro26Ala determined at 2.0 A resolution. Pro26 in Fis occurs at the point where a flexible extended beta-hairpin arm leaves...

  11. Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme.

    Science.gov (United States)

    Bagot, Kathleen L; Cadilhac, Dominique A; Kim, Joosup; Vu, Michelle; Savage, Mark; Bolitho, Les; Howlett, Glenn; Rabl, Justin; Dewey, Helen M; Hand, Peter J; Denisenko, Sonia; Donnan, Geoffrey A; Bladin, Christopher F

    2017-12-01

    Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.

  12. Cosmetic surgery in Australia: a risky business?

    Science.gov (United States)

    Parker, Rhian

    2007-08-01

    Cosmetic surgery is increasing in popularity in Australia and New Zealand, as it is across other Western countries. However, there is no systematic mechanism for gathering data about cosmetic surgery, nor about the outcomes of that surgery. This column argues that the business of cosmetic surgery in Australia has questionable marketing standards, is conducted with little scrutiny or accountability and offers patients imperfect knowledge about cosmetic procedures. It also argues that while medical practitioners debate among themselves over who should carry out cosmetic procedures, little attention has been paid to questionable advertising in the industry and even less to highlighting the real risks of undergoing cosmetic surgery. While consumers are led to believe that cosmetic surgery is accessible, affordable and safe, they are sheltered from the reality of invasive and risky surgery and from the ability to clearly discern that all cosmetic procedures carry risk. While doctors continue to undertake advertising and engage in a territorial war, they fail to address the really important issues in cosmetic surgery. These are: providing real evidence about what happens in the industry, developing stringent regulations under which the industry should operate and ensuring that all patients considering cosmetic surgery are fully informed as to the risks of that surgery.

  13. Two-port access versus four-port access laparoscopic ovarian cystectomy.

    Science.gov (United States)

    Choi, Won-Kyu; Kim, Jang-Kew; Yang, Jung-Bo; Ko, Young-Bok; Nam, Sang-Lyun; Lee, Ki-Hwan

    2014-09-01

    This study was conducted to compare the surgical outcomes between two-port access and four-port access laparoscopic ovarian cystectomy. Four hundred and eighty nine patients who had received two-port access laparoscopic ovarian cystectomy (n=175) and four-port access laparoscopic ovarian cystectomy (n=314) in Chungnam National University Hospital from January 2009 to August 2012 were analyzed retrospectively. The data were compared between the bilaterality of the cysts and cyst diameter of less than 6 cm and 6 cm or more. There were no significant differences in patient's age, parity, body weight, body mass index and history of previous surgery between the two-port and four-port access laparoscopy group. Bilaterality of ovarian cysts was more in fourport access laparoscopy group (13.7% vs. 32.5%, P=0.000). There were no significant differences in operation time, hemoglobin change, hospital stay, adhesiolysis, transfusion, and insertion of hemo-vac between the two-port and four-port access laparoscopy group for size matched compare. However additional analgesics were more in four-port access laparoscopy group for unilateral ovarian cystectomy. Two-port access laparoscopic surgery was feasible and safe for unilateral and bilateral ovarian cystectomy compare with four-port access laparoscopic surgery.

  14. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee...... a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach...

  15. Robotic systems in spine surgery.

    Science.gov (United States)

    Onen, Mehmet Resid; Naderi, Sait

    2014-01-01

    Surgical robotic systems have been available for almost twenty years. The first surgical robotic systems were designed as supportive systems for laparoscopic approaches in general surgery (the first procedure was a cholecystectomy in 1987). The da Vinci Robotic System is the most common system used for robotic surgery today. This system is widely used in urology, gynecology and other surgical disciplines, and recently there have been initial reports of its use in spine surgery, for transoral access and anterior approaches for lumbar inter-body fusion interventions. SpineAssist, which is widely used in spine surgery, and Renaissance Robotic Systems, which are considered the next generation of robotic systems, are now FDA approved. These robotic systems are designed for use as guidance systems in spine instrumentation, cement augmentations and biopsies. The aim is to increase surgical accuracy while reducing the intra-operative exposure to harmful radiation to the patient and operating team personnel during the intervention. We offer a review of the published literature related to the use of robotic systems in spine surgery and provide information on using robotic systems.

  16. Heart failure - surgeries and devices

    Science.gov (United States)

    CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Other Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons ...

  20. Hip Replacement Surgery

    Science.gov (United States)

    ... Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB Download ... What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or diseased ...

  1. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  2. Laser surgery - skin

    Science.gov (United States)

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  3. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Surgery Dental Implant Surgery Facial Cosmetic Surgery Head, Neck and Oral Pathology Obstructive Sleep Apnea TMJ and Facial Pain Treatment of Facial Injury Wisdom Teeth Management Procedures ...

  5. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: ... Care . 5th ed. Philadelphia, PA: Elsevier; 2017:chap 37. LeRoy S, ...

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and ... Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries ...

  7. What Is Refractive Surgery?

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...

  8. LASIK - Laser Eye Surgery

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on ... without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) Your dentist, orthodontist and ...

  10. Management of biliary symptoms after bariatric surgery.

    Science.gov (United States)

    Brockmeyer, Joel R; Grover, Brandon T; Kallies, Kara J; Kothari, Shanu N

    2015-12-01

    Biliary disease requiring intervention can be complicated in the postbariatric surgery patient. A retrospective review was completed to identify patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from September 2001 to September 2014, and those who underwent biliary intervention were identified. A total of 1527 patients underwent bariatric surgery during the study period. Of the 1,112 patients without prior cholecystectomy, 91 (8%) had biliary symptoms requiring intervention. Ninety patients underwent cholecystectomy, with 86 successfully completed laparoscopically. Six patients required laparoscopy-assisted percutaneous transgastric endoscopic retrograde cholangiopancreatography along with cholecystectomy to clear gallstones from the common bile duct. Three patients who had undergone cholecystectomy before bariatric surgery developed primary common bile duct stones. Surgery for biliary disease after bariatric surgery can be completed successfully with minimal complications, and percutaneous transgastric endoscopic retrograde cholangiopancreatography has a high success rate of access to and clearance of the biliary tree. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Training in breast surgery in Spain.

    Science.gov (United States)

    Miguelena, José M; Domínguez Cunchillos, Fernando

    2016-01-01

    Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Robotics in Sinus and Skull Base Surgery.

    Science.gov (United States)

    Rangarajan, Sanjeet; Hachem, Ralph Abi; Ozer, Enver; Beer-Furlan, Andre; Prevedello, Daniel; Carrau, Ricardo L

    2017-06-01

    Transoral robotic surgery (TORS) has been proven to be safe and to yield acceptable oncological and functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis. TORS has been successful at reducing morbidity, improving quality of life, and providing access to areas that previously required mandibulotomy or other more radical approaches in the past. This has changed the paradigm of management of tumors in these anatomic locations. In this article, the authors review the recent literature discussing the role of robotic surgery in managing sinonasal and skull base pathology and discuss its current advantages and limitations. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Bariatric surgery waiting times in Canada.

    Science.gov (United States)

    Christou, Nicolas V; Efthimiou, Evangelos

    2009-06-01

    Severe obesity is reaching epidemic proportions throughout the world, including Canada. The only permanent treatment of severe or morbid obesity is bariatric surgery. Access to bariatric surgery is very limited in Canada. We sought to collect accurate data on waiting times for the procedure. We carried out a survey of members of the Canadian Association of Bariatric Physicians and Surgeons and performed a more detailed analysis within Quebec and at one Canadian bariatric surgery centre where a prospectively collected bariatric surgery registry has been maintained since 1983. The survey response rate was 85%. All centres determined whether patients were eligible for bariatric surgery based on the National Institutes of Health criteria. Patients entered the queue as "office contacts" and moved through the queue, with the exit point being completion of the procedure. In 2007, a total of 6783 patients were waiting for bariatric surgery and 1313 procedures were performed in Canada. Assuming these trends are maintained, the calculated average waiting time for bariatric surgery in Canada is just over 5 years (6783/1313). The Fraser Institute and the Wait Times Alliance benchmarks for reasonable surgical waiting times vary from 8 weeks for cancer surgery to 18 months for cosmetic surgery. At one Canadian centre, 12 patients died while waiting for bariatric surgery. The waiting times for bariatric surgery are the longest of any surgically treated condition. Given the significant reduction in the relative risk of death with bariatric surgery (40%-89% depending on the study), the current waiting times for the procedure in Canada are unacceptable.

  14. History of Laparoscopy Surgery: Particularities about its Introduction and Development in Cuba

    OpenAIRE

    Pérez Martínez, Caridad de Jesús; Universidad de Ciencias Médicas de La Habana

    2016-01-01

    Minimal access surgery has been a true revolution in the field of surgery, especially in general surgery, with the apparition of laparoscopy surgery. In this article has been made a bibliographic research with one main purpose: To describe the antecedents, origins, and development of the minimal access surgery and laparoscopy surgery in Cuba and around the world. Recent publications have been consulted, and, finally, we counting with thirty bibliographic references. A relevant conclusion has ...

  15. Proposal of a computerized algorithm for continuous wave CO2 laser on-line control during orthopaedic surgery. Phase II: simplified algorithm version (LCA-s) and helmet-mounted data access device solution.

    Science.gov (United States)

    Canestri, F

    1997-08-01

    This paper is the continuation of the Phase I report published in 1992 by Canestri. It contains recent findings on how to speed-up the process of sublimated volume forecasting for a TEM11* CO2 laserbeam in CW mode following an original model proposed by the author--called LCA--here presented in a simplified version (LCA-s) on PMMA (polymethylmethacrilate) samples. Other interesting parameters, such as the time required to create the minimal injury vb along with its physical interpretations, are reported and explained. TEM11*, TEM01* and TEM00 beams profiles are also compared and discussed for LCA-s. The results of both Phase I and Phase II of this investigation can be integrated in one single solution package for the end-user, combining fast decisions making and operational features. The final part of this paper describes the 'helmet-mounted' data recall visor methodology which allows the surgeon to access to a data base for information retrieval during the course of an operation without interrupting the surgical case itself. This particularly interesting application allows the surgeon to consult a centrally-located data base which contains important information regarding similar clinical cases, choice of laserbeam profiles and focal lengths, simulation of beam behaviours, performances and other data. The on-line and direct access to the data base supports him in all those borderline situations in the O.R. in which the laser device type and configuration/calibration play a device role in the success of the operation. Also, the helmet-mounted display frees surgeon's hands in order to allow him to continue the operation while consulting the data base on-line, thus speeding up decision processes regarding changes of laser set-up, general calibration optimization and remote clinical consultancy.

  16. General surgery in crisis - the critical shortage | Kahn | South African ...

    African Journals Online (AJOL)

    South African Journal of Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 44, No 3 (2006) >. Log in or Register to get access to full text downloads.

  17. Validation of the Euroscore on Cardiac Surgery Patients in Nairobi ...

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 2 (2017) >. Log in or Register to get access to full text downloads.

  18. Reconstructive maxillofacial surgery in a resource poor setting ...

    African Journals Online (AJOL)

    Nigerian Journal of Plastic Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 8, No 1 (2012) >. Log in or Register to get access to full text downloads.

  19. Letter to the Editor | Mirza | Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 3 (2014) >. Log in or Register to get access to full text downloads.

  20. Letter to the Editor | Khan | Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 4 (2016) >. Log in or Register to get access to full text downloads.

  1. The mysterious pleural effusion | Simao | Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 3 (2014) >. Log in or Register to get access to full text downloads.

  2. Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs.

    Science.gov (United States)

    Cortellini, Pierpaolo; Buti, Jacopo; Pini Prato, Giovanpaolo; Tonetti, Maurizio S

    2017-01-01

    Compare the long-term outcomes and costs of three treatment modalities in intra-bony defects. Forty-five intra-bony defects in 45 patients had been randomly allocated to receive: modified papilla preservation technique with titanium-reinforced expanded-polytetrafluoroethylene (ePTFE) membranes (MPPT Tit, N = 15); access flap with expanded-PTFE membranes (Flap-ePTFE, N = 15) and access flap alone (Flap, N = 15). Supportive periodontal care (SPC) was provided monthly for 1 year, then every 3 months for 20 years. Periodontal therapy was delivered to sites showing recurrences. Forty-one patients complied with SPC. Four subjects were lost to follow-up. Clinical attachment-level differences between 1 and 20 years were -0.1 ± 0.3 mm (p = 0.58) in the MPPT Tit; -0.5 ± 0.1 mm (p = 0.003) in the Flap-ePTFE and -1.7 ± 0.4 mm (p MPPT Tit (1.4 ± 0.4 mm; p = 0.008) and to Flap-ePTFE (1.1 ± 0.4 mm; p = 0.03). Flap group lost two treated teeth. Five episodes of recurrences occurred in the MPPT Tit, six in the Flap-ePTFE and fifteen in the Flap group. Residual pocket depth at 1-year was significantly correlated with the number of recurrences (p = 0.002). Sites treated with flap had greater OR for recurrences and higher costs of re-intervention than regenerated sites over a 20-year follow-up period with SPC. Regeneration provided better long-term benefits than Flap: no tooth loss, less periodontitis progression and less expense from re-intervention over a 20-year period. These benefits need to be interpreted in the context of higher immediate costs associated with regenerative treatment. These initial observations need to be extended to larger groups and broader clinical settings. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Gastric Bypass Surgery

    Science.gov (United States)

    ... gastrointestinal system Death (rare) Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They ... room, where medical staff monitors you for any complications. Your hospital stay may ... of bariatric surgery Each type of bariatric surgery has pros and ...

  4. Facial Cosmetic Surgery

    Science.gov (United States)

    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  6. Corrective Jaw Surgery

    Science.gov (United States)

    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  7. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We Are Find a Surgeon News Videos Contact Anesthesia Cleft Lip/Palate and Craniofacial Surgery Corrective Jaw Surgery Dental Implant Surgery Extractions and Other Oral Surgeries Facial Cosmetic ...

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ...

  9. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Procedures Who is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery Life ... Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ...

  11. Development of Models for Regional Cardiac Surgery Centers

    Directory of Open Access Journals (Sweden)

    Choon Seon Park

    2016-12-01

    Full Text Available Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness, three models were developed: the ‘independent regional cardiac surgery center’ model, the ‘satellite cardiac surgery center within hospitals’ model, and the ‘extended cardiac surgery department within hospitals’ model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

  12. Surgery, public health, and Pakistan.

    Science.gov (United States)

    Zafar, Syed Nabeel; McQueen, K A Kelly

    2011-12-01

    Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

  13. Cosmetic Surgery and the Practice of Medicine

    African Journals Online (AJOL)

    rising ethical issues in this article. The first is the ... of business. The idea that consumers are sovereign is fundamental to a market economy. This is because personal preference and capital largely determine access to a product or service. ... to business success.3 Is the practice of cosmetic surgery the same? Certainly, to ...

  14. Hemodialysis access -- self care

    Science.gov (United States)

    ... hemodialysis. Taking good care of your access helps make it last longer. Prevent Infection in Your Access Keep your access clean. Wash the access with soap and water every day to decrease your risk ...

  15. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid Christine; Neumann, Gudrun

    2014-01-01

    in postmenopausal women was associated with surgery including hysterectomy and bilateral oophorectomy (pcarcinoma was found 138 times (95% CI: 48, 275) more prevalent than the expected rate. CONCLUSION......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  16. The Impact of Psychological Support on Weight Loss Post Weight Loss Surgery: a Randomised Control Trial

    OpenAIRE

    Ogden, J; Hollywood, A; Pring, C

    2015-01-01

    BACKGROUND: The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service (BRS) on patient weight loss following bariatric surgery at 1 year. METHODS: A single-site open-randomised parallel group control trial based at St. Richard's Hospital in Chichester in the UK. Patients (n = 162) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual (n = 80) or the BRS (n = 82). The...

  17. Population perception of surgical safety and body image trauma: a plea for scarless surgery?

    Science.gov (United States)

    Bucher, Pascal; Pugin, François; Ostermann, Sandrine; Ris, Frederic; Chilcott, Michael; Morel, Philippe

    2011-02-01

    Laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES) are prospected as the future of minimally invasive surgery. While scarless surgery (NOTES and LESS) is gaining increasing popularity, perception of these approaches should be investigated. An anonymous questionnaire describing laparoscopy, LESS, and NOTES was given to medical staff (n=120), paramedical staff (n=100), surgical patients (n=100), and the general population (n=100). The survey participants (median age, 37 years; range, 18-81 years) were queried about their expectations for surgical treatment and their approach preference. The first concern of the survey responders was the risk of surgical complications (92%). When asked about the respective importance of surgical safety, cure, and cosmetics, cure was placed first by 74%, safety by 33%, and cosmetics by 3%. These results were not influenced by sex, age, prior surgery or endoscopy, or education. When operative risk was similar, 90% of the participants preferred a scarless approach (75% preferred LESS and 15% preferred NOTES) to laparoscopy. The scarless approach preference was significantly higher among the younger participants (agerisks. Although cure and safety remain the main concern, the population has a favorable perception of scarless surgery, even in the case of increased procedural risk, with LESS favored over NOTES. Such a popular adoption of scarless surgery should warrant the promotion of further research, technological innovations, and the establishment of surgeon training to improve its safety.

  18. Surgery for Stress Urinary Incontinence

    Science.gov (United States)

    ... Surgery for Stress Urinary Incontinence Page Navigation ▼ ACOG Pregnancy Book Surgery for Stress Urinary Incontinence Patient Education FAQs Surgery for Stress Urinary Incontinence Patient Education ...

  19. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  20. Mimic mini-laparoscopic surgery is a simple and secure approach using direct placement of 3-mm trocars without noticeable scars.

    Science.gov (United States)

    Ichikawa, Masao; Akira, Shigeo; Hamano, Eri; Ono, Shuichi; Mine, Katsuya; Takeshita, Toshiyuki

    2013-01-01

    Minimally invasive surgery is widely used in gynecology. Women who seek a cosmetic advantage (i.e., concealed scars) choose minimally invasive surgery. Although laparoendoscopic single-site surgery could be an ideal solution, some of our patients have had cosmetic problems, such as pigmentation and cicatrix of the umbilicus. In addition, umbilical eversion and umbilical herniation occasionally develop. Therefore, mini-laparoscopic surgery using 3-mm trocars can be recommended for patients who do not want the natural appearance of the navel to be altered. We have developed an approach to achieve a superior cosmetic outcome by direct placement of 3-mm trocars in the lateral wall of the abdomen and at the lower border of the pubic hair. We refer to this method as mimic mini-laparoscopic surgery and report cases in which this procedure was used.

  1. Weight Loss Surgery

    Science.gov (United States)

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you ... caused by obesity. There are different types of weight loss surgery. They often limit the amount of food ...

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... administer local anesthesia, all forms of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft ...

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  4. Preparing for Surgery

    Science.gov (United States)

    ... FAQs Preparing for Surgery Page Navigation ▼ ACOG Pregnancy Book Preparing for Surgery Patient Education FAQs Preparing for ... the person who is in charge of giving anesthesia and checking its effects. What can I do ...

  5. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... Global Affairs and Humanitarian Efforts Log In Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Laparoscopic Spine Surgery Your spine surgeon has determined that you ...

  6. Heart valve surgery

    Science.gov (United States)

    ... techniques are used: Percutaneous surgery (through the skin) Robot-assisted surgery If your surgeon can repair your ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  7. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, bone and ...

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  9. Cosmetic ear surgery

    Science.gov (United States)

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the ... are not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, ...

  13. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ...

  14. Abdominal wall surgery

    Science.gov (United States)

    Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty ... Most of the time, this surgery is an elective or cosmetic procedure because it is an operation you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair ...

  15. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  17. Refractive corneal surgery - discharge

    Science.gov (United States)

    ... after surgery, it should be OK to use artificial tears. Check with your provider. DO NOT wear contact lenses on the eye that had surgery, even if you have blurry vision. DO NOT use any makeup, creams, or lotions ...

  18. Smoking and surgery

    Science.gov (United States)

    Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...

  19. Robotic liver surgery

    Science.gov (United States)

    Leung, Universe

    2014-01-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  20. RADIATION AND SURGERY

    African Journals Online (AJOL)

    Dr. S.A. Adewuyi

    of radical surgical procedures, surgery remains the only potential curative treatment for many cancer patients ... catheter, 'Toilet' procedure, e.g. simple mastectomy or amputation of a limb, for fungating tumours. Debulking .... that tumour is irradiated prior to surgery and post- operative implies after surgery. 10. Pre-operative.

  1. Cavus Foot Surgery

    Science.gov (United States)

    ... Toes All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A cavus or high-arched foot may have ... related problems. What are the goals of cavus foot surgery? The main goal of surgery is to ...

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...

  3. Breast Cancer Surgery

    Science.gov (United States)

    FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...

  4. VT Limited Access Highways

    Data.gov (United States)

    Vermont Center for Geographic Information — A limited-access road, known by various terms worldwide, including limited-access highway, dual carriageway, expressway, and partial controlled access highway, is a...

  5. Accessibility and sensory experiences

    DEFF Research Database (Denmark)

    Ryhl, Camilla

    2010-01-01

    and accessibility. Sensory accessibility accommodates aspects of a sensory disability and describes architectural design requirements needed to ensure access to architectural experiences. In the context of architecture accessibility has become a design concept of its own. It is generally described as ensuring...... physical access to the built environment by accommodating physical disabilities. While the existing concept of accessibility ensures the physical access of everyone to a given space, sensory accessibility ensures the choice of everyone to stay and be able to participate and experience....

  6. Fishing Access Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — The Vermont Fish & Wildlife Department maintains developed fishing access areas. These sites provide public access to waters in Vermont for shore fishing...

  7. Robotic surgery is ready for prime time in India: Against the motion

    Directory of Open Access Journals (Sweden)

    Tehemton E Udwadia

    2015-01-01

    Full Text Available The use of Robotic Surgery as a purported adjunct and aid to Minimal Access Surgery (MAS is growing in several areas. The acknowledged advantages as also the obvious and hidden disadvantages of Robotic Surgery are highlighted. Survey of literature shows that while Robotic Surgery is "feasible" and the results are "comparable" there is no convincing evidence that it is any better than MAS or even open surgery in most areas. To move "Robotic Surgery is ready for prime time in India" with no less than two dozen robots, many sub-optimally utilized for a population of 1.2 billion seems untenable.

  8. Modified distal revascularization with interval ligation procedure for steal syndrome after arteriovenous fistula creation for hemodialysis access

    NARCIS (Netherlands)

    van der Meer, Saskia; Zeebregts, Clark; Tielliu, Ignacc; Verhoeven, Eric; van den Dungen, Jan

    2007-01-01

    Patients diagnosed with steal syndrome after hemodialysis access surgery have a few options for symptom relief while maintaining vascular access. These include fistula lengthening, banding, distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI) or proximalization

  9. The practice of minimal access surgery in Nigeria. Challenges and ...

    African Journals Online (AJOL)

    submucous fibroids,endometrial synechiae and septum,abdominal adhesiolysis, Salpingectomy,oophorectomy,cystectomy,myomectomy and hysterectomy (P = 0.001- 0.07 and 0.02-0.001 in FMC and TH respectively) with most of the differences been ...

  10. Minimal access surgery for multiorgan hydatid cysts | Mishra ...

    African Journals Online (AJOL)

    Multiorgan hydatid cysts caused by larval growth of Echinococcus granulosus, is a rare condition in paediatric age group. There are very few reports of management of multiorgan hydatid cysts, involving lung, liver, and spleen by minimally invasive approach in paediatric age group. Herewith, we are reporting a case of ...

  11. Editorial The Evolution of Minimal Access Surgery and the ...

    African Journals Online (AJOL)

    KIGZ

    acquired in skills laboratories using surgical trainers, animal models, virtual reality trainers, or other simulated operating conditions before the trainee performs these procedures in the operating ... courses” involving animal labs. Predictably, there followed a spike of surgical misadventures and an increased rate of common ...

  12. DEVELOPMENT OF PLASTIC SURGERY.

    Science.gov (United States)

    Pećanac, Marija Đ

    2015-01-01

    Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.

  13. JISC Open Access Briefing Paper

    OpenAIRE

    Swan, Alma

    2005-01-01

    What Open Access is. What Open Access is not. How is Open Access provided? Open Access archives or repositories. Open Access journals. Why should authors provide Open Access to their work? Further information and resources

  14. Application of objective clinical human reliability analysis (OCHRA) in assessment of technical performance in laparoscopic rectal cancer surgery.

    Science.gov (United States)

    Foster, J D; Miskovic, D; Allison, A S; Conti, J A; Ockrim, J; Cooper, E J; Hanna, G B; Francis, N K

    2016-06-01

    Laparoscopic rectal resection is technically challenging, with outcomes dependent upon technical performance. No robust objective assessment tool exists for laparoscopic rectal resection surgery. This study aimed to investigate the application of the objective clinical human reliability analysis (OCHRA) technique for assessing technical performance of laparoscopic rectal surgery and explore the validity and reliability of this technique. Laparoscopic rectal cancer resection operations were described in the format of a hierarchical task analysis. Potential technical errors were defined. The OCHRA technique was used to identify technical errors enacted in videos of twenty consecutive laparoscopic rectal cancer resection operations from a single site. The procedural task, spatial location, and circumstances of all identified errors were logged. Clinical validity was assessed through correlation with clinical outcomes; reliability was assessed by test-retest. A total of 335 execution errors identified, with a median 15 per operation. More errors were observed during pelvic tasks compared with abdominal tasks (p technical performance of laparoscopic rectal surgery.

  15. Success and complication parameters for laparoscopic surgery: a benchmark for natural orifice transluminal endoscopic surgery.

    Science.gov (United States)

    Gutt, C N; Müller-Stich, B P; Reiter, M A

    2009-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) currently represents an issue of particular interest among surgeons and gastroenterologists. The principle of NOTES is the reduction of the operative trauma by using natural orifices of the human body to access the abdominal cavity. Regarding the tendency to further minimization of the surgical trauma, NOTES may be considered as a logical step in the evolution of minimally invasive surgery. Pioneers of this technique regard NOTES as the successor to laparoscopic surgery in enabling surgeons and gastroenterologists to conduct scarless surgery. This might not only lead to better cosmetic results but also enhance the prospect of decreases in wound infections and incisional hernias, as well as reducing operative stress, postoperative immobility, and pain. In this article the authors collect and review the existing literature concerning NOTES and establish a benchmark for the assessment of this new technique by stating results from conventional minimally invasive surgery as the gold standard. It is shown that publications investigating possible advantages or long-term results of NOTES are scarce. However, the investigation and verification of potential advantages and disadvantages represent the most important step in the development of a new technique. Only proven advantages would justify the broad implementation of a new technique in relation to its specific risks. Conventional laparoscopic surgery as the current standard of minimally invasive surgery will be the benchmark for NOTES with regard to most issues. Superiority of NOTES in at least several issues would be the best argument for its further implementation into clinical practice.

  16. Access to surgical assistance: challenges and perspectives

    Directory of Open Access Journals (Sweden)

    Maria Fernanda do Prado Tostes

    2016-01-01

    Full Text Available Objective to characterize the access to surgical assistance in Brazil. Method documentary study, with a quantitative approach, developed from information of the Caixa Preta da Saúde [Health Black Box] database, of the Brazilian Medical Association. Results in the one-year period 3773 cases related to health care in Brazil were recorded. There were 458 (12.3% records on surgical assistance. Of these, most, 339 (74.1%, involved the lack of access in all regions of Brazil. The main access constraint was the prolonged waiting time for surgery. Other constraints were the excessive waiting for medical appointment with experts, doing examinations and cancellation of surgeries. Conclusion the access to surgical assistance, by users of the Brazilian health system, is not widely guaranteed, reinforcing the need for integrated governmental actions, organization of the health care network, management of health care and human resources to overcome the challenges imposed to achieve the Universal Access to Health and Universal Health Coverage.

  17. Global patient outcomes after elective surgery

    DEFF Research Database (Denmark)

    2016-01-01

    - and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN51817007....... adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration...... of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients...

  18. [Breast cancer surgery].

    Science.gov (United States)

    Vlastos, Georges; Berclaz, Gilles; Langer, Igor; Pittet-Cuenod, Brigitte; Delaloye, Jean-François

    2007-10-24

    Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.

  19. Gastric and intestinal surgery.

    Science.gov (United States)

    Fossum, Theresa W; Hedlund, Cheryl S

    2003-09-01

    Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

  20. Annals of surgery

    National Research Council Canada - National Science Library

    1885-01-01

    Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various...

  1. [Surgery of adrenal tumors].

    Science.gov (United States)

    Bondarenko, V O; Ermolov, A S; Kovalenko, T I; Kondratiev, A V

    2004-01-01

    From 1983 to 2003 examination and surgical treatment were performed in 463 patients with different adrenal tumors. Hormone-active tumors were revealed in 249 of them, non-active - in 214. Combination of CT or MRT with study of adrenal hormones is the basis of the diagnosis. In different cases multispiral computed tomography, angiography, selected taking of blood from inferior caval vein, US- or CT-guided biopsy were used. Open surgery through thoracofrenolumbotomy was performed in 392 patients, videolaparoscopic surgery - in 71. Expediency of laparoscopic surgery in line with open surgery is demonstrated.

  2. Hyperoxaluria and Bariatric Surgery

    Science.gov (United States)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  3. Oncoplastic breast surgery.

    Science.gov (United States)

    Pillarisetti, Raghu Ram; Querci Della Rovere, Guidubaldo

    2012-06-01

    Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated 'Oncoplastic Breast Surgeons'. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.

  4. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  5. Annals of surgery

    National Research Council Canada - National Science Library

    Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various...

  6. [Crohn's disease surgery].

    Science.gov (United States)

    Kala, Zdeněk; Marek, Filip; Válek, Vlastimil A; Bartušek, Daniel

    2014-01-01

    Surgery of Crohns disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohns disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries.

  7. World Wide Access: Accessible Web Design.

    Science.gov (United States)

    Washington Univ., Seattle.

    This brief paper considers the application of "universal design" principles to Web page design in order to increase accessibility for people with disabilities. Suggestions are based on the World Wide Web Consortium's accessibility initiative, which has proposed guidelines for all Web authors and federal government standards. Seven guidelines for…

  8. Well-defined silica supported aluminum hydride: another step towards the utopian single site dream?† †Electronic supplementary information (ESI) available. See DOI: 10.1039/c5sc02276b Click here for additional data file.

    Science.gov (United States)

    Werghi, Baraa; Bendjeriou-Sedjerari, Anissa; Sofack-Kreutzer, Julien; Jedidi, Abdesslem; Abou-Hamad, Edy

    2015-01-01

    of a strained siloxane bridge, Si–O–Si but with two different mechanisms, showing that the reality of “single site” catalyst may be an utopia: DFT calculations indicate that isobutyl transfer occurs via a simple metathesis between the Al-isobutyl and O–Si bonds, while hydride transfer occurs via a two steps mechanism, the first one is a β-H elimination to Al with elimination of isobutene, whereas the second is a metathesis step between the formed Al–H bond and a O–Si bond. Thermal treatment of 1a (at 250 °C) under high vacuum (10–5 mbar) generates Al–H through a β-H elimination of isobutyl fragment. These supported well-defined Al–H which are highly stable with time, are tetra, penta and octa coordinated as demonstrated by IR and 27Al–1H J-HMQC NMR spectroscopy. All these observations indicate that surfaces atoms around the site of grafting play a considerable role in the reactivity of a single site system. PMID:28757945

  9. Training and assessment in functional endoscopic sinus surgery.

    Science.gov (United States)

    Chan, M; Carrie, S

    2018-02-01

    Functional endoscopic sinus surgery is a common procedure performed within otolaryngology, but it carries potential for significant life-changing complications. It is therefore essential that trainees undergo adequate training. The European Working Time Directive has led to reduced operating time for the trainee surgeon. With variable access and the cost implications associated with cadaveric specimens, simulation can be an invaluable educational resource in surgical training. The current literature regarding the various simulation methodologies that have been used in functional endoscopic sinus surgery training is discussed. A literature search was conducted using the key words 'nasal', 'nasal polyps', 'endoscope', 'education and simulation', 'endoscopic sinus surgery' and 'training'. Twelve articles were identified; of these, eight trialled the use of simulators, two utilised ovine models and two used task trainers. Simulation has shown benefit in functional endoscopic sinus surgery training; however, a robust platform accessible to ENT trainees is lacking.

  10. Professional Access 2013 programming

    CERN Document Server

    Hennig, Teresa; Hepworth, George; Yudovich, Dagi (Doug)

    2013-01-01

    Authoritative and comprehensive coverage for building Access 2013 Solutions Access, the most popular database system in the world, just opened a new frontier in the Cloud. Access 2013 provides significant new features for building robust line-of-business solutions for web, client and integrated environments.  This book was written by a team of Microsoft Access MVPs, with consulting and editing by Access experts, MVPs and members of the Microsoft Access team. It gives you the information and examples to expand your areas of expertise and immediately start to develop and upgrade projects. Exp

  11. Access 2010 Programmer's Reference

    CERN Document Server

    Hennig, Teresa; Griffith, Geoffrey L

    2010-01-01

    A comprehensive guide to programming for Access 2010 and 2007. Millions of people use the Access database applications, and hundreds of thousands of developers work with Access daily. Access 2010 brings better integration with SQL Server and enhanced XML support; this Wrox guide shows developers how to take advantage of these and other improvements. With in-depth coverage of VBA, macros, and other programming methods for building Access applications, this book also provides real-world code examples to demonstrate each topic.: Access is the leading database that is used worldwide; While VBA rem

  12. Contemporary endodontic surgery.

    Science.gov (United States)

    Rubinstein, Richard; Torabinejad, Mahmoud

    2004-06-01

    During the past decade, endodontics has seen a dramatic shift in the application of periradicular surgery and the role it plays in endodontic treatment. With the introduction of enhanced magnification, periradicular ultrasonics and other associative technologies, teeth that might otherwise be extracted now have a chance for retention. This article describes the role of these advances in contemporary endodontic surgery.

  13. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...

  14. Robust surgery loading

    NARCIS (Netherlands)

    Hans, Elias W.; Wullink, Gerhard; van Houdenhoven, Mark; Kazemier, Geert

    2008-01-01

    We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This

  15. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  16. Prehabilitation Before Major Surgery

    OpenAIRE

    Johnson Francis

    2018-01-01

    Prehabilitation is a new term for preoperative rehabilitation before major surgery. Some authors use the short form 'Prehab', though it is not so widely used. Prehabilitation involves measures to improve the physical, physiological, metabolic and psychosocial reserves in preparation for an elective surgery. This involves exercise, nutrition, education and psychosocial interventions.

  17. Annals of African Surgery

    African Journals Online (AJOL)

    The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of ...

  18. Economics of epilepsy surgery

    Directory of Open Access Journals (Sweden)

    Venkatraman Sadanand

    2014-01-01

    Full Text Available Objective: Surgical decision-making is a complex process. First, a medical decision is made to determine if surgery is necessary. Second, another medical decision is made to determine the type of surgery. Third, a corporate decision is made if such a surgery is financially feasible. Finally, a legal decision is made to proceed or refuse the chosen surgery. This paper examines these issues in the case of surgery for medically intractable epilepsy and proposes a method of decision analysis to guide epilepsy surgery. Materials and Methods: A stochastic game of imperfect information using techniques of game theory and decision analysis is introduced as an analytical tool for surgical decision-making. Results: Surgery for appropriately chosen patients suffering from medically intractable epilepsy may not only be feasible, but may be the best medical option and the best financial option for the patient, families, society and the healthcare system. Such a situation would then make it legally or ethically difficult to reject or postpone surgery for these patients. Conclusions: A process to collect data to quantify the parameters used in the decision analysis is hereby proposed.

  19. Cosmetic breast surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000273.htm Cosmetic breast surgery - discharge To use the sharing features on this ... Editorial team. Related MedlinePlus Health Topics Plastic and Cosmetic Surgery Browse the Encyclopedia A.D.A.M., Inc. ...

  20. [Cognitive deterioration after surgery

    DEFF Research Database (Denmark)

    Steinmetz, J.; Rasmussen, L.S.

    2008-01-01

    Delirium and postoperative cognitive dysfunction are important and common complications after surgery. Risk factors are first of all increasing age and type of surgery, whereas the type of anaesthesia does not seem to play an important role. Mortality is higher among patients with cognitive...

  1. Bariatric surgery and fertility.

    Science.gov (United States)

    Shah, Divya K; Ginsburg, Elizabeth S

    2010-06-01

    Bariatric surgery is the most reliable way to sustain weight loss in the morbidly obese. Reproductive age women comprise the majority of bariatric patients, and many may be interested in conceiving after surgery. The purpose of this review is to synthesize the recent literature on bariatric surgery and fertility to assist providers in patient counseling. Obesity adversely impacts fecundability and IVF outcomes through a variety of mechanisms. The body of literature on reproductive outcome after bariatric surgery is sparse and of mixed quality. Bariatric surgery has been shown to improve menstrual cyclicity in anovulatory women, but little is published on the impact of surgical weight loss on spontaneous or IVF-treatment-related pregnancy rates. The increased risk of miscarriage in obese women may decline after bariatric surgery. There are currently insufficient data to support recommendations regarding the ideal timing for pregnancy after bariatric surgery. Obesity has been shown to adversely impact fertility, and weight loss is associated with significant improvement in many parameters of reproductive function. Further research is required as to the specific impact of surgical weight loss on pregnancy and miscarriage rates, as well as the optimal timing of pregnancy after bariatric surgery.

  2. Sinus surgery: optimal surgery, optimal outcome?

    NARCIS (Netherlands)

    Fokkens, Wytske J.

    2016-01-01

    Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness

  3. Revision endoscopic sinonasal surgery.

    Science.gov (United States)

    Cantillano, Pablo; Rubio, Fabián; Naser, Alfredo; Nazar, Rodolfo

    Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  4. Overview: Routes to Open Access

    OpenAIRE

    Tullney, Marco; van Wezenbeek, Wilma

    2017-01-01

    Slides of an overview presentation given at a CESAER workshop on Open Access, February 2nd, 2017, in Brussels Cover major routes to more open access as discussed in the Task Force Open Science of CESAER: (national) open access strategies open access mandates open access incentives open access awareness open access publishing open access infrastructure

  5. Design for Accessibility

    DEFF Research Database (Denmark)

    Herriott, Richard

    2012-01-01

    A report on how nine rail builder, operators and transport designers deal with design for accessibility......A report on how nine rail builder, operators and transport designers deal with design for accessibility...

  6. Physical Access Control Database -

    Data.gov (United States)

    Department of Transportation — This data set contains the personnel access card data (photo, name, activation/expiration dates, card number, and access level) as well as data about turnstiles and...

  7. Aortic valve surgery - minimally invasive

    Science.gov (United States)

    ... valve surgery. Techniques include min-thoracotomy, min-sternotomy, robot-assisted surgery, and percutaneous surgery. To perform the ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  8. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

  9. Tests and visits before surgery

    Science.gov (United States)

    Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...

  10. Gamma knife surgery for craniopharyngioma

    International Nuclear Information System (INIS)

    Prasad, D.; Steiner, M.; Steiner, L.

    1995-01-01

    We present our results of Gamma Knife surgery for craniopharyngioma in nine patients. The current status of surgery, radiation therapy, intracavitary instillation of radionuclides and Gamma Knife surgery in the management of craniopharyngiomas is discussed. (author)

  11. Getting yourself healthy before surgery

    Science.gov (United States)

    ... 3 months after certain surgeries (joint replacement or heart valve surgery). So be sure to schedule your dental ... Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice . 20th ed. Philadelphia, ...

  12. Cosmetic Surgery: Regulatory Challenges in a Global Beauty Market.

    Science.gov (United States)

    Griffiths, Danielle; Mullock, Alex

    2017-02-28

    The market for cosmetic surgery tourism is growing with an increase in people travelling abroad for cosmetic surgery. While the reasons for seeking cosmetic surgery abroad may vary the most common reason is financial, but does cheaper surgery abroad carry greater risks? We explore the risks of poorly regulated cosmetic surgery to society generally before discussing how harm might be magnified in the context of cosmetic tourism, where the demand for cheaper surgery drives the market and makes surgery accessible for increasing numbers of people. This contributes to the normalisation of surgical enhancement, creating unhealthy cultural pressure to undergo invasive and risky procedures in the name of beauty. In addressing the harms of poorly regulated surgery, a number of organisations purport to provide a register of safe and ethical plastic surgeons, yet this arguably achieves little and in the absence of improved regulation the risks are likely to grow as the global market expands to meet demand. While the evidence suggests that global regulation is needed, the paper concludes that since a global regulatory response is unlikely, more robust domestic regulation may be the best approach. While domestic regulation may increase the drive towards foreign providers it may also have a symbolic effect which will reduce this drive by making people more aware of the dangers of surgery, both to society and individual physical wellbeing.

  13. Review of transvaginal natural orifice transluminal endoscopic surgery in gynecology

    Directory of Open Access Journals (Sweden)

    Naoyuki Yoshiki

    2017-02-01

    Full Text Available Recent technologic advances in endoscopic instrumentation and optics have allowed the development of a less invasive alternative to conventional laparoscopic surgery. During the past decade, natural orifice transluminal endoscopic surgery (NOTES flourished in the field of general surgery, and it has emerged as a new concept of minimally invasive surgery. NOTES yields access to the abdominal cavity without any incisions on the abdominal wall (scarless surgery, and the natural orifices of the body surface, such as the mouth and the vagina, serve as the gateway to the peritoneal cavity. In gynecology, the vagina of a woman can be considered as an additional route for surgery. Recently, clinical application of transvaginal NOTES has broadened significantly in gynecology. Using transvaginal NOTES by applying the method of single-incision laparoscopic surgery via the vaginal route, not only adnexal surgery and hysterectomy, but also myomectomy and oncologic surgery could be performed safely and effectively in selected patients. In future, further studies should be conducted to evaluate the true clinical feasibility and safety of transvaginal NOTES.

  14. The medicalization of obesity, bariatric surgery, and population health.

    Science.gov (United States)

    Ortiz, Selena E; Kawachi, Ichiro; Boyce, Angie M

    2017-09-01

    This article examines how the medicalization of obesity validates the use of bariatric surgery to treat obesity in the United States and how expansions in access to bariatric surgery normalize surgical procedures as disease treatment and prevention tools. Building on this discussion, the article poses two questions for population health regarding health technology: (1) to what extent does bariatric surgery treat obesity in the United States while diverting attention away from the ultimate drivers of the epidemic and (2) to what extent does bariatric surgery improve outcomes for some groups in the US population while simultaneously generating disparities? We conduct a brief, historical analysis of the American Medical Association's decision to reclassify obesity as a disease through internal documents, peer-reviewed expert reports, and major media coverage. We use medicalization theory to show how this decision by the American Medical Association channels increased focus on obesity into the realm of medical intervention, particularly bariatric surgery, and use this evidence to review research trends on bariatric surgery. We propose research questions that investigate the population health dimensions of bariatric surgery in the United States and note key areas of future research. Our objective is to generate a discourse that considers bariatric surgery beyond the medical realm to better understand how technological interventions might work collectively with population-level obesity prevention efforts and how, in turn, population health approaches may improve bariatric surgery outcomes.

  15. Open Access Alternatives

    Science.gov (United States)

    Tenopir, Carol

    2004-01-01

    Open access publishing is a hot topic today. But open access publishing can have many different definitions, and pros and cons vary with the definitions. Open access publishing is especially attractive to companies and small colleges or universities that are likely to have many more readers than authors. A downside is that a membership fee sounds…

  16. Open Access @ DTU

    DEFF Research Database (Denmark)

    Ekstrøm, Jeannette

    Open Access is high on the agenda in Denmark and internationally. Denmark has announced a national strategy for Open Access that aims to achieve Open Access to 80% in 2017 and 100% in 2022 to peer review research articles. All public Danish funders as well as H2020 requires that all peer review a...

  17. Anesthesia for bariatric surgery.

    Science.gov (United States)

    Nishiyama, Tomoki; Kohno, Yumiko; Koishi, Keiko

    2012-02-01

    Bariatric surgery has a lot of problems in anesthesia. We retrospectively compared anesthesia for bariatric surgery in yellow race with that in normal weight patients. Twenty patients who received bariatric surgery and 20 normal body weight patients who received abdominal surgery in Japan were enrolled. Induction condition, depth of epidural space, dose of anesthetics, duration of the effects of muscle relaxants, ventilation, and fluid management in bariatric surgery were analyzed and compared with those in normal body weight patients. An epidural catheterization was successful under ultrasound guide in the bariatric group. The depth epidural space was significantly larger in the bariatric group. Cormack and Lehane classification and the number of intubation attempt were not different between the two groups, while one bariatric case was once awakened to intubate blindly. Pressure-controlled ventilation was used in the bariatric group. Four bariatric patients were continuously ventilated after surgery. The doses of anesthetics and fluid infusion rate were not different between the two groups when calculated by ideal body weight in the bariatric group. The duration of the effects of rocuronium and pancuronium were shorter in the bariatric group. For anesthesia of yellow race patients undergoing bariatric surgery, intravenous anesthetics and acetate Ringer's solution with 1% glucose could be administered per ideal body weight, the effects of muscle relaxants lasted shorter, pressure-controlled ventilation could keep oxygenation with adequate carbon dioxide, and ultrasound assist was useful in epidural catheterization in the bariatric patients.

  18. Journal of Orthopaedic Surgery and Research Editorial

    Directory of Open Access Journals (Sweden)

    Chan Kai-Ming

    2006-09-01

    Full Text Available Abstract Journal of Orthopaedic Surgery and Research is an open access, online journal that aims to expeditiously publish clinical and basic research studies related to musculoskeletal issues in different cultural communities. It provides a platform for exchanges of new clinical and scientific information in the most precise and expeditious way to achieve dissemination of information and cross-fertilization of ideas. The open access nature of this journal allows articles to be universally and freely accessible via the Internet. This ensures a rapid and efficient communication of research findings. The journal welcomes all types of articles related to musculoskeletal issues. Its timely publication and high visibility are the two most important features that make this journal different from other traditional journals in the orthopaedic field.

  19. Vascular access in critical limb ischemia.

    Science.gov (United States)

    Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L

    2016-01-01

    Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Uptake of cataract surgery in Sava Region, Madagascar: role of cataract case finders in acceptance of cataract surgery.

    Science.gov (United States)

    Razafinimpanana, Narivony; Nkumbe, Henry; Courtright, Paul; Lewallen, Susan

    2012-04-01

    The number of people coming for cataract surgery in Madagascar remains low and most ophthalmologists could do many more surgeries than currently done. Knowing why people identified with cataract do not accept surgery will help to design programs that use existing resources more effectively. The study was carried out in Sava Region of Madagascar. People with blinding (acceptance were proximity to hospital (people from Sambava district were twice as likely to present as people from more distant districts) and perceived price of transport and food (being higher for people not accepting). The actual price of surgery was not the main barrier to acceptance of surgery; instead it appears that distance to the hospital and the willingness to pay are important predictors. Strategies to improve uptake need to be revised in order to ensure that people have access to and use cataract surgical services.

  1. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. There have been some extraordinary accomplishments in that time, which have led to enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source that surveys surgery theory and its applications. Indeed, no one person could write such a survey. The sixtieth birthday of C. T. C. Wall, one of the leaders of the founding generation of surgery theory, provided an opportunity to rectify the situation and produce a

  2. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. The sixtieth birthday (on December 14, 1996) of C.T.C. Wall, a leading member of the subject''s founding generation, led the editors of this volume to reflect on the extraordinary accomplishments of surgery theory as well as its current enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source surveying surgery theory and its applications. Because no one person could write such a survey, the editors ask

  3. Keratomycosis after cataract surgery.

    Science.gov (United States)

    Mendicute, J; Orbegozo, J; Ruiz, M; Sáiz, A; Eder, F; Aramberri, J

    2000-11-01

    To evaluate cases and results of keratomycosis that developed after cataract surgery. Hospital de Guipúzcoa, San Sebastián, Spain. This retrospective study comprised 8 patients who developed keratomycosis soon after cataract surgery. Culture analysis revealed 7 cases of Aspergillus fumigatus and 1 of Aspergillus flavus. After medical treatment with antifungal agents, 6 cases resolved and 2 required evisceration. The presence of fungi in corneal ulcers that develop after cataract surgery should be considered. Initiation of early treatment determines the prognosis. Among the therapeutic options, collagen shields soaked in amphotericin B may be effective.

  4. A robot for transnasal surgery featuring needle-sized tentacle-like arms.

    Science.gov (United States)

    Gilbert, Hunter; Hendrick, Richard; Remirez, Andria; Webster, Robert

    2014-01-01

    This paper discusses a new class of robots known as concentric tube robots and their application to transnasal skull base surgery. The endonasal approach has clear benefits for patients, but the surgery presents challenges that strongly motivate the use of robotic tools. In this paper, the concentric tube robot concept is described, and preliminary experimental results for transnasal skull base surgery are reviewed. Just as the da Vinci robot has revolutionized many laparoscopic surgeries, we expect concentric tube robots will enable the advancement of skull base surgery and the development of other minimally invasive procedures that require access through constrained paths.

  5. Android Access Control Extension

    Directory of Open Access Journals (Sweden)

    Anton Baláž

    2015-12-01

    Full Text Available The main objective of this work is to analyze and extend security model of mobile devices running on Android OS. Provided security extension is a Linux kernel security module that allows the system administrator to restrict program's capabilities with per-program profiles. Profiles can allow capabilities like network access, raw socket access, and the permission to read, write, or execute files on matching paths. Module supplements the traditional Android capability access control model by providing mandatory access control (MAC based on path. This extension increases security of access to system objects in a device and allows creating security sandboxes per application.

  6. Access 2013 for dummies

    CERN Document Server

    Ulrich Fuller, Laurie

    2013-01-01

    The easy guide to Microsoft Access returns with updates on the latest version! Microsoft Access allows you to store, organize, view, analyze, and share data; the new Access 2013 release enables you to build even more powerful, custom database solutions that integrate with the web and enterprise data sources. Access 2013 For Dummies covers all the new features of the latest version of Accessand serves as an ideal reference, combining the latest Access features with the basics of building usable databases. You'll learn how to create an app from the Welcome screen, get support

  7. Pro Access 2010 Development

    CERN Document Server

    Collins, Mark

    2011-01-01

    Pro Access 2010 Development is a fundamental resource for developing business applications that take advantage of the features of Access 2010 and the many sources of data available to your business. In this book, you'll learn how to build database applications, create Web-based databases, develop macros and Visual Basic for Applications (VBA) tools for Access applications, integrate Access with SharePoint and other business systems, and much more. Using a practical, hands-on approach, this book will take you through all the facets of developing Access-based solutions, such as data modeling, co

  8. [Cosmetic surgery among Norwegian women].

    Science.gov (United States)

    von Soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar; Skolleborg, Knut Chr

    2004-07-01

    There are few data on the frequency of cosmetic surgery among Norwegian women. A random sample of 2000 Norwegian women aged 22 to 55 received a questionnaire on cosmetic surgery, demographic data, self-esteem, and to what extent people around them accepted cosmetic surgery. The response rate was 46% (907 women). Of these, 7.7% indicated that they had undergone cosmetic surgery, while 22.6% wished to do so. Other people's degree of acceptance predicted both the wish to undergo cosmetic surgery and already conducted surgery. Low self-esteem was correlated with a wish to undergo surgery, though women who had done surgery had no lower self-esteem than non-patients. Although the response rate was relatively low, this study gives the first reliable data on the frequency of cosmetic surgery in Norway. The results indicate that other people's degree of acceptance of cosmetic surgery is a predictor of such surgery being chosen.

  9. Repetitive endoscopic sinus surgery failure: a role for radical surgery?

    NARCIS (Netherlands)

    Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.

    2006-01-01

    OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the

  10. Cosmetic surgery: medicolegal considerations.

    Science.gov (United States)

    Piras, Mauro; Delbon, Paola; Conti, Adelaide; Graziano, Vincenzo; Capasso, Emanuele; Niola, Massimo; Bin, Paola

    2016-01-01

    Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB) was also analyzed. The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.

  11. [Pregnancy after bariatric surgery].

    Science.gov (United States)

    Tzur, Tamar; Sheiner, Eyal

    2011-06-01

    Recent research has put the spotlight on two different aspects of pregnancy after bariatric surgery: safety of the mother and fetus, and the procedure's effectiveness in preventing the complications surrounding reproduction and pregnancy often seen in the obese woman. To evaluate the pregnancy outcome foLlowing bariatric surgery. Although there are severaL reports documenting poor perinatal outcomes and late surgical complications during pregnancies subsequent to bariatric surgery, systematic studies have generaLLy not proven such an association. Pregnancy after bariatric surgery appears to be safe, and in general perinatal outcome is better when compared to pregnancies of obese women. Providers should be familiar with potential complications related to postoperative pregnancies and be prepared to provide appropriate interventions such as nutritional supplementation and band adjustment when necessary.

  12. Gastric Sleeve Surgery

    Science.gov (United States)

    ... regular exercise has family members who will provide emotional and practical support (like driving to every doctor's visit or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this ...

  13. Breast augmentation surgery

    Science.gov (United States)

    ... care - open Images Breast lift (mastopexy) - series Breast reduction (mammoplasty) - series Breast augmentation - series References Maxwell GP, Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013: ...

  14. Oophorectomy (Ovary Removal Surgery)

    Science.gov (United States)

    ... symptoms, such as hot flashes and vaginal dryness Depression or anxiety Heart disease Memory problems Decreased sex drive Osteoporosis Premature death Taking low doses of hormone replacement drugs after surgery and until about age ...

  15. [Pregnancy after bariatric surgery].

    Science.gov (United States)

    Pepe, Franco; DE Luca, Francesco; Stracquadanio, Mariagrazia; Garraffo, Claudia; Santonocito, Veronica C; Privitera, Agata

    2017-04-01

    Pregnancy after bariatric surgery has some peculiarities related to obesity, type of surgery, amount of weight loss, time elapsed from the surgery and adherence to medical prescriptions. Pregnant woman is at risk of nutritional deficiencies and it is unclear whether there is an increased incidence of intestinal complications during pregnancy after bariatric surgery and whether this kind of complications are more frequent during cesarean section. The fetus is at high risk of prematurity and fetal growth restriction, but they seem not at increased risk of birth defects (DTN) except in individual cases of folic acid deficiency (DTN) or vitamin K defect (similar abnormalities in patients receiving oral anticoagulants). In addition, the incidence of gestational diabetes and hypertension results to be decreased. Other postnatal outcomes from possible epigenetic modifications need to be evaluated in the long-term postnatal follow-up.

  16. Bariatric Surgery Misconceptions

    Science.gov (United States)

    ... quality of life than someone who is normal weight. Bariatric surgery results in highly significant improvement in psychosocial well- ... affecting an individual’s weight, such as psychological issues. Weight gain generally occurs when there is an energy imbalance ...

  17. Deep breathing after surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000440.htm Deep breathing after surgery To use the sharing features on ... way to do so is by doing deep breathing exercises. Deep breathing keeps your lungs well-inflated ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced ... make the lips meet without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) ...

  19. Art and Plastic Surgery.

    Science.gov (United States)

    Fernandes, Julio Wilson; Metka, Susanne

    2016-04-01

    The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  20. Blood donation before surgery

    Science.gov (United States)

    ... very safe, some people choose to use a method called autologous blood donation. Autologous blood is blood donated by you, which you later receive if you need a transfusion during or after surgery. You can have blood ...

  1. Nigerian Journal of Surgery

    African Journals Online (AJOL)

    Comparative efficacy of amoxicillin/clavulanic acid and levofloxacin in the reduction of postsurgical sequelae after third molar surgery: A randomized, double blind, clinical trial in a Nigerian University Teaching Hospital.

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and orthodontist understand that this is a long-term commitment for you and your family, and will ... face, mouth and jaw surgery Contact Us Sitemap Terms of Use Privacy Policy © Copyright AAOMS 2008-2018 ...

  3. Retrosternal thyroid surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007558.htm Retrosternal thyroid surgery To use the sharing features on this page, please enable JavaScript. The thyroid gland is normally located at the front of ...

  4. Surgery - Multiple Languages

    Science.gov (United States)

    ... 简体中文) Expand Section Biopsy - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Getting Your Skin Ready for Surgery - 简体中文 (Chinese, ...

  5. Heart Surgery - Multiple Languages

    Science.gov (United States)

    ... Coronary Artery Bypass Surgery - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Pacemaker - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF ...

  6. After Surgery - Multiple Languages

    Science.gov (United States)

    ... After Total Joint Replacement - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Home Care Instructions After Surgery - 简体中文 (Chinese, Simplified ( ...

  7. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ ...

  8. Robotics in Colorectal Surgery.

    Science.gov (United States)

    Weaver, Allison; Steele, Scott

    2016-01-01

    Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.

  9. Blepharoplasty (Eyelid Surgery)

    Science.gov (United States)

    ... lid blepharoplasty is almost always done just for cosmetic reasons. Risks Possible risks of eyelid surgery include: Infection and bleeding Dry, irritated eyes Difficulty closing your eyes or other eyelid problems Noticeable scarring Injury to eye muscles Skin discoloration ...

  10. Alternative Refractive Surgery Procedures

    Science.gov (United States)

    ... the epithelial cells. Once the epithelial flap is created and moved aside, the procedure is the same ... Sites EyeWiki International Society of Refractive Surgery * Required * First Name: * Last Name: Member ID: * Phone Number: * Email: * ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do ... out more. Who We Are Find a Surgeon News Videos Contact Administration of Anesthesia Cleft Lip/Palate ...

  12. LASIK Eye Surgery

    Science.gov (United States)

    ... your eye. Overcorrections may be more difficult to fix than undercorrections. Astigmatism. Astigmatism can be caused by ... back into place. The flap usually heals without stitches. During the surgery, you'll be asked to ...

  13. Orthopaedics in day surgery

    African Journals Online (AJOL)

    emergency patients for a surgical procedure, returning home the same day (1). Ambulatory orthopaedics happens to have double meaning, so in this communication day surgery will be the preferred term. In Kenya the three models of day.

  14. Cosmetic surgery: medicolegal considerations

    Directory of Open Access Journals (Sweden)

    Piras Mauro

    2016-01-01

    Full Text Available Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB was also analyzed. Conclusion: The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.

  15. Breast Reduction Surgery

    Science.gov (United States)

    ... Breast reduction surgery might also help improve your self-image and your ability to participate in physical activities. ... under the breasts Nerve pain Restricted activity Poor self-image related to large breasts Difficulty fitting into bras ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...

  17. Expectations of Sinus Surgery

    Science.gov (United States)

    ... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... reduce the pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who ... surgeons surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and ...

  19. Shoulder surgery - discharge

    Science.gov (United States)

    ... repair Shoulder arthroscopy Shoulder CT scan Shoulder MRI scan Shoulder ... by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...

  20. Endoscopic Sinus Surgery

    Science.gov (United States)

    ... vitamins, herbal remedies, and spices including vitamin E, garlic, ginger, gingko, and ginseng may increase the risk of bleeding. Some patients may be asked to take antibiotics and/or steroids prior to sinus surgery. This ...

  1. The Biocarbon vascular access device (DiaTAB) for haemodialysis.

    Science.gov (United States)

    Smits, P J; Slooff, M J; Lichtendahl, D H; van der Hem, G K

    1985-01-01

    The Biocarbon vascular access device (DiaTAB) is a relatively new method in secondary access surgery. Punctures, often the cause of complications can be avoided because it is a no-needle method of dialysis. However thrombosis due to stenosis of the venous anastomosis or of the efferent vein is a continuing problem. A new experience is the fibrin flap formation under the plug of the device, which can be removed easily.

  2. Bariatric Surgery for Obesity.

    Science.gov (United States)

    le Roux, Carel W; Heneghan, Helen M

    2018-01-01

    In this review, the authors discuss the indications for and the published outcomes of commonly performed bariatric procedures, including weight loss, perioperative morbidity and mortality, late complications, as well as the impact of bariatric surgery on comorbidities, cardiovascular risk, and mortality. They also briefly discuss the mechanisms by which bariatric/metabolic surgery causes such significant weight loss and health gain. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Is day surgery safe?

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Engbæk, J; Bartholdy, Jens

    2012-01-01

    Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort.......Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort....

  4. Robotics in General Surgery

    OpenAIRE

    Wall, James; Chandra, Venita; Krummel, Thomas

    2008-01-01

    In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...

  5. Plastic surgery pitfalls.

    Science.gov (United States)

    Gorney, M

    1999-01-01

    As a founding member of the physician-owned insurance carrier The Doctors' Company, the author has reviewed many plastic surgery policy claims. In this article, he presents an overview of the plastic surgery procedures that produce the most severe losses. He then offers suggestions on how to proceed with these "medical malpractice favorites." The author discusses potential antitrust traps and legal recourse for plastic surgeons.

  6. Minimally Invasive Abdominal Surgery

    OpenAIRE

    Richardson, William S.; Carter, Kristine M.; Fuhrman, George M.; Bolton, John S.; Bowen, John C.

    2000-01-01

    In the last decade, laparoscopy has been the most innovative surgical movement in general surgery. Minimally invasive surgery performed through a few small incisions, laparoscopy is the standard of care for the treatment of gallbladder disease and the gold standard for the treatment of reflux disease. The indications for a laparoscopic approach to abdominal disease continue to increase, and many diseases may be treated with laparoscopic techniques. At Ochsner, laparoscopic techniques have dem...

  7. Surgery for Acute Pancreatitis

    OpenAIRE

    Navadgi, Suresh; Pandanaboyana, Sanjay; Windsor, John A.

    2015-01-01

    Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the ...

  8. Day surgery in Bristol.

    Science.gov (United States)

    Carrington, S

    1993-02-01

    As in the rest of the United Kingdom, day surgery in Bristol is on the increase. In the Bristol Royal Infirmary day surgery unit (DSU) we treat approximately 3,500 patients a year. We have recently opened a second operating theatre. This has shifted the proportion of cases from our general theatres. This has also improved our case mix, less minor surgery under local anaesthetics, to more of the recommended 'basket type' surgery ie hernia repair, varicose vein surgery, excision of breast lumps etc. We have recently introduced an appointment booking system that is progressing. Such changes have to be introduced with good preparation, communication and a lot of diplomacy. I would like to outline the management aspects that help to expand and improve on the service we give, including patient selection and the appointment booking system we have introduced. I will describe how we drew up a policy involving the organisation of operation lists and staff involvement in day surgery management and accountability for patient care from admission through to discharge including our latest care plan. Finally I will outline the methods we have developed for evaluating the care we give.

  9. Metabolic surgery: quo vadis?

    Science.gov (United States)

    Ramos-Leví, Ana M; Rubio Herrera, Miguel A

    2014-01-01

    The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  10. Telemedicine and Plastic Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Denis Souto Valente

    2015-01-01

    Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

  11. Free flap surgery at a Medical Centre in Kashmir: a five year ...

    African Journals Online (AJOL)

    Nigerian Journal of Plastic Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 1 (2009) >. Log in or Register to get access to full text downloads.

  12. Understanding Antegrade Colonic Enema (ACE) Surgery

    Science.gov (United States)

    ... Colonic Enema (ACE) Surgery Antegrade Colonic Enema (ACE) Surgery Antegrade colonic enema surgery (ACE) is a procedure ... Risks / Benefits What is antegrade colonic enema (ACE) surgery? Antegrade colonic enema surgery (ACE) or Malone antegrade ...

  13. Access Data Analysis Cookbook

    CERN Document Server

    Bluttman, Ken

    2008-01-01

    This book offers practical recipes to solve a variety of common problems that users have with extracting Access data and performing calculations on it. Whether you use Access 2007 or an earlier version, this book will teach you new methods to query data, different ways to move data in and out of Access, how to calculate answers to financial and investment issues, how to jump beyond SQL by manipulating data with VBA, and more.

  14. Strategic Accessibility Competition

    OpenAIRE

    Bacchiega, Emanuele; Randon, Emanuela; Zirulia, Lorenzo

    2010-01-01

    We analyze the effect of competition in market-accessibility enhancement among quality-differentiated firms. Firms are located in regions with different ex-ante transport costs to reach the final market. We characterize the equilibrium of the two-stage game in which firms first invest to improve market accessibility and then compete in prices. Efforts in accessibility improvement crucially depend on the interplay between the willingness to pay for the quality premium of the median consumer an...

  15. Access control Tutorial 5

    CERN Document Server

    CERN. Geneva; Oberknapp, Bernd

    2007-01-01

    This tutorial will review current access management technologies and invite participants to discuss use cases and requirements for access management, particularly with respect to scholarly archives and their users. The presenters will describe the concepts and architecture of Federated Access Management (FAM) with reference to some large-scale federation implementations, and discuss the challenges faced particularly in Identity Management by academic institutions. The tutorial will include a practical demonstration of how FAM can be applied to an Open Archive repository.

  16. Are PDF Documents Accessible?

    Directory of Open Access Journals (Sweden)

    Mireia Ribera Turró

    2008-09-01

    Full Text Available Adobe PDF is one of the most widely used formats in scientific communications and in administrative documents. In its latest versions it has incorporated structural tags and improvements that increase its level of accessibility. This article reviews the concept of accessibility in the reading of digital documents and evaluates the accessibility of PDF according to the most widely established standards.

  17. Open Access Monitor - DK

    DEFF Research Database (Denmark)

    Svendsen, Michael; Hansen, Lars Asger Juel; Andersen, Dorte

    2017-01-01

    Open Access Monitor - DK (OAM-DK) is a 2-year DEFF funded [DEFF.2016-0018] national project running in 2017-2018 with the aim of collecting, documenting and administrating Open Access publishing costs. OAM-DK is lead by Copenhagen University Library under the Royal Danish Library with participation...... of all Danish University Libraries. This poster presents the first results of Open Access costs related to 2015 publications at the The University of Copenhagen....

  18. Access 2013 bible

    CERN Document Server

    Alexander, Michael

    2013-01-01

    A comprehensive reference to the updated and new features of Access 2013 As the world's most popular database management tool, Access enables you to organize, present, analyze, and share data as well as build powerful database solutions. However, databases can be complex. That's why you need the expert guidance in this comprehensive reference. Access 2013 Bible helps you gain a solid understanding of database purpose, construction, and application so that whether you're new to Access or looking to upgrade to the 2013 version, this well-rounded resource provides you with a th

  19. Demystifying Open Access

    International Nuclear Information System (INIS)

    Mele, Salvatore

    2007-01-01

    The tenets of Open Access are to grant anyone, anywhere and anytime free access to the results of scientific research. HEP spearheaded the Open Access dissemination of scientific results with the mass mailing of preprints in the pre-WWW era and with the launch of the arXiv preprint system at the dawn of the '90s. The HEP community is now ready for a further push to Open Access while retaining all the advantages of the peer-review system and, at the same time, bring the spiralling cost of journal subscriptions under control. I will present a possible plan for the conversion to Open Access of HEP peer-reviewed journals, through a consortium of HEP funding agencies, laboratories and libraries: SCOAP3 (Sponsoring Consortium for Open Access Publishing in Particle Physics). SCOAP3 will engage with scientific publishers towards building a sustainable model for Open Access publishing, which is as transparent as possible for HEP authors. The current system in which journals income comes from subscription fees is replaced with a scheme where SCOAP3 compensates publishers for the costs incurred to organise the peer-review service and give Open Access to the final version of articles. SCOAP3 will be funded by all countries active in HEP under a 'fair share' scenario, according to their production of HEP articles. In this talk I will present a short overview of the history of Open Access in HEP, the details of the SCOAP3 model and the outlook for its implementation.

  20. Market Access and Welfare

    DEFF Research Database (Denmark)

    Raimondos-Møller, Pascalis; Woodland, Alan D.

    According to the literature, well known tariff reform rules that are guaranteed to increase welfare will not necessarily increase market access, while rules that are guaranteed to increase market access will not necessarily increase welfare. Such conflict between welfare and market access...... access and consumer welfare will always be weakly compatible, in the sense that reforms based on each objective have the same signed effect on the other objective. For strong compatibility, whereby both objectives increase as a result of a locally optimal tariff reform, we derive both a necessary...

  1. OGIS Access System

    Data.gov (United States)

    National Archives and Records Administration — The OGIS Access System (OAS) provides case management, stakeholder collaboration, and public communications activities including a web presence via a web portal.

  2. Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

    Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a

  3. Utilization of day surgery services at Upper hill Medical Centre and ...

    African Journals Online (AJOL)

    Introduction: Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in ...

  4. Single-port access laparoscopic abdominoperineal resection through the colostomy site: a case report

    DEFF Research Database (Denmark)

    Lauritsen, Morten; Bulut, O

    2012-01-01

    Single-port access (SPA) laparoscopic surgery is emerging as an alternative to conventional laparoscopic and open surgery, although its benefits still have to be determined. We present the case of a 87-year-old woman who underwent abdominoperineal resection (APR) with SPA. The abdominal part...

  5. Robotic Surgery for Thyroid Disease

    OpenAIRE

    Lee, Jandee; Chung, Woong Youn

    2013-01-01

    Robotic surgery is an innovation in thyroid surgery that may compensate for the drawbacks of conventional endoscopic surgery. A surgical robot provides strong advantages, including three-dimensional imaging, motion scaling, tremor elimination, and additional degrees of freedom. We review here recent adaptations, experience and applications of robotics in thyroid surgery. Robotic thyroid surgeries include thyroid lobectomy, total thyroidectomy, central compartment neck dissection, and radical ...

  6. The scope of plastic surgery | Rogers | South African Journal of ...

    African Journals Online (AJOL)

    South African Journal of Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 51, No 3 (2013) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  7. Outcome of Strabismus Surgery by Nonadjustable Suture among ...

    African Journals Online (AJOL)

    2017-03-06

    Mar 6, 2017 ... Outcome of strabismus surgery by nonadjustable suture among adults attending a university hospital of. Saudi Arabia. Niger J Clin Pract 2017;20:335-40. This is an open access article distributed under the terms of the Creative Commons. Attribution-Non Commercial-Share Alike 3.0 License, which allows ...

  8. Book Review: Robotic Surgery by G Watanabe | Dawka | Archives of ...

    African Journals Online (AJOL)

    Archives of Medical and Biomedical Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 1, No 3 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Book Review: Robotic Surgery by G ...

  9. Plastic Surgery in Nigeria-Scope and Challenges | Chukwuanuku ...

    African Journals Online (AJOL)

    Nigerian Journal of Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 17, No 2 (2011) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...

  10. The Surgeon and Advocacy | Mwenda | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 1 (2015) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. The Surgeon and Advocacy. AS Mwenda, MD Mwachiro. Abstract. No Abstract.

  11. The Surgeon and Advocacy | Mwenda | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 1 (2015) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...

  12. Nasogastric tube self-knotting | Abbas | Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 4 (2016) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...

  13. Letter to the Editor | Khan | Annals of Pediatric Surgery

    African Journals Online (AJOL)

    Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 4 (2016) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...

  14. Affordability of cataract surgery using the Big Mac prices

    Directory of Open Access Journals (Sweden)

    Van C. Lansingh

    2015-01-01

    Conclusion: The price of cataract surgery does not consider the patient's capacity to pay, based on a simple tool such as the BMcI. This suggests affordability issues, particularly when patients work for minimum wages and/or do not have access to free health care.

  15. Tumour, Torsion or Trauma? | Nduhiu | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 4 (2009) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web browser ...

  16. Editorial: Surgical Audit | Ogendo | Annals of African Surgery

    African Journals Online (AJOL)

    Annals of African Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5 (2010) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Editorial: Surgical Audit. S.W.O Ogendo. Abstract. No Abstract. Full Text:.

  17. Nasotracheal Intubation in Children for Outpatient Dental Surgery: Is ...

    African Journals Online (AJOL)

    2018-02-23

    Feb 23, 2018 ... in Children for Outpatient Dental Surgery: Is Fiberoptic Bronchoscopy. Useful?. Niger J Clin Pract 2018;21:183-8. This is an open access article distributed under the terms of the Creative Commons. Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the ...

  18. Editorial Challenging barriers to surgical access in lower and middle ...

    African Journals Online (AJOL)

    care.1. Sub-Saharan Africa is one area singled out as having one of the greatest unmet surgical needs globally.2 Barriers to surgical access lead to delayed presentation of disease. As a consequence ... et al. who showed that elective day of surgery cancellation rates in an. 800-bed ... average cost per operation. Of greater ...

  19. Ethical issues of obesity surgery--a health technology assessment.

    Science.gov (United States)

    Saarni, Samuli I; Anttila, Heidi; Saarni, Suoma E; Mustajoki, Pertti; Koivukangas, Vesa; Ikonen, Tuija S; Malmivaara, Antti

    2011-09-01

    New surgical technologies may challenge societal values, and their adoption may lead to ethical challenges. Despite proven cost-effectiveness, obesity (bariatric) surgery and its public funding have been questioned on ethical arguments relating to, for example, the self-inflicted or non-disease nature of obesity. Our aim was to analyze the ethical issues relevant to bariatric surgery. A comprehensive health technology assessment was conducted on bariatric surgery for morbid obesity using the EUnetHTA method, including a fully integrated ethical analysis. The ethical arguments suggesting that obesity should not be surgically treated because it is self-inflicted were rejected. Medicalization of obesity may have both positive and negative effects that impact the various stakeholders differently, thus being difficult to balance. Informing bariatric surgery patients and actively supporting their autonomy is exceptionally important, as the benefits and harms of both obesity and bariatric surgery are complex, and the outcome depends on how well the patient understands and adheres to the life-long changes in eating habits required. Justice considerations are important in organizing surgical treatment of obesity, as the obese are discriminated against in many ways and obesity is more common in socioeconomically disadvantaged populations who might have problems of access to treatments. Obesity should be treated like other diseases in health care, and obesity surgery rationed like other cost-effective treatments. Positive actions to ensure patient autonomy and just access to surgical treatments may be warranted.

  20. Lasers in oral surgery and implantology

    Science.gov (United States)

    Vescovi, Paolo

    2016-03-01

    The usefulness of laser for oral hard tissue procedure such as caries treatment, impacted teeth extraction, periodontal therapy, peri-implantitis management, sinus lifting is reported by several Authors [1]. Conventionally, mechanical rotary instruments and hand instruments are employed for bone surgery. Rotary instruments have better accessibility and cutting efficiency, but there is a risk of excessive heating of bone tissue and caution must be exercised to avoid the bur becoming entangled with surrounding soft tissues and the reflected flap. The main clinical advantages of the lasers are represented by minimal patient discomfort, good recovery with decreased or absent post-operative pain. In the last ten years are described in the international literature great advantages of Laser Surgery and Low Level Laser Therapy (LLLT) performed with different wavelength in addition to traditional surgical techniques to improve bone and soft tissue healing and for pain and infection control.