Journal articles on the topic 'Intra-operative errors'
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Haklar, Uğur, Ertuğrul Ulusoy, and Tayfun Şimşek. "Radiological Comparison and Functional Outcomes of Robotic Assisted Medial Unicompartmental Knee Arthroplasty with Metal-Backed Onlay Tibial Components." Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0010. http://dx.doi.org/10.1177/2325967117s00101.
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Robotic surgery studies have been increasing considering operative advantages on reducing error and improving functional success in partial knee arthroplasty. We have been curious whether planning and application of knee implants assisted robotically correspond to their radiological outcomes. Moreover, we were also curious about functional outcomes. Methods: Data were prospectively collected in 42 patients (62 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – December 2015 For evaluation of components’ accuracy, intra-operative robotic analyses were compared with post-operative radiographic alignment. Statistical analysis was done on these values using paired T-Test. Additionally in our clinic with an average follow-up time of 22 months. Clinical outcomes were evaluated with American Knee Society Scoring (AKSS) System. Results: Difference between intra-operative robotic plans and post-operative radiographs was evaluated for the flexion angle of the femoral component, posterior slope of the tibial component and the varus angle of the tibial component. A novel method is used to evaluate the varus angle of the tibial component. All of the errors are <=0.5°, approximately 86% of the errors are <=0.3° while 18% of errors are zero. No significant difference was observed statistically (paired t-test, p<0.05). Post-operatively all 42 patients had excellent knee scores (mean, 99.67) and functional scores (mean, 99.04) on AKSS while pre-operatively 2 were scored fair, 40 were score poor, and functionally 14 were scored fair and 28 were scored poor. Conclusion: The difference between robotic plans and radiographic outcomes was statistically not significant where metal-backed onlay tibial components were used.
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Khoramnia, Ramin, Gerd Auffarth, Grzegorz Łabuz, George Pettit, and Rajaraman Suryakumar. "Refractive Outcomes after Cataract Surgery." Diagnostics 12, no. 2 (January 19, 2022): 243. http://dx.doi.org/10.3390/diagnostics12020243.
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A post-operative manifest refractive error as close as possible to target is key when performing cataract surgery with intraocular lens (IOL) implantation, given that residual astigmatism and refractive errors negatively impact patients’ vision and satisfaction. This review explores refractive outcomes prior to modern biometry; advances in biometry and its impact on patients’ vision and refractive outcomes after cataract surgery; key factors that affect prediction accuracy; and residual refractive errors and the impact on visual outcomes. There are numerous pre-, intra-, and post-operative factors that can influence refractive outcomes after cataract surgery, leaving surgeons with a small “error budget” (i.e., the source and sum of all influencing factors). To mitigate these factors, precise measurement and correct application of ocular biometric data are required. With advances in optical biometry, prediction of patient post-operative refractory status has become more accurate, leading to an increased proportion of patients achieving their target refraction. Alongside improvements in biometry, advancements in microsurgical techniques, new IOL technologies, and enhancements to IOL power calculations have also positively impacted patients’ refractory status after cataract surgery.
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Groom, Robert, Joan Tryzelaar, Richard Forest, Kevin Niimi, Giovanni Cecere, Desmond Donegan, Saul Katz, et al. "Intra-operative quality assessment of coronary artery bypass grafts." Perfusion 16, no. 6 (December 2001): 511–18. http://dx.doi.org/10.1177/026765910101600611.
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Early coronary artery bypass graft (CABG) failure is a troubling complication that may result in a wide range of problems, including refractory angina, myocardial infarction, low cardiac output, arrhythmia, and fatal heart failure. Early graft failures are related to poor quality and size of the distal native vascular bed, coagulation abnormalities, or technical problems involving the graft conduits and anastomoses. Unfortunately, graft failure is difficult to detect during surgery by visual assessment, palpation, or conventional monitoring. We evaluated the accuracy and utility of a transit-time, ultrasonic flow measurement system for measurement of CABGs. There were no differences between transit-time measurements and volumetric-time collected samples in an in vitro circuit over a range of flows from 10 to 100 ml/min (Bland and Altman Plot, 1.96 SD). Two hundred and ninety-eight CABGs were examined in 125 patients. Graft flow rate was proportional to the target vessel diameter. Nine technical errors were detected and corrected. Flow waveform morphology provided valuable information related to the quality of the anastamosis, which led to the immediate correction of technical problems at the time of surgery.
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Gorišek, B., M. Rebolj Stare, and I. Krajnc. "Accuracy of Intra-Operative Frozen Section Analysis of Ovarian Tumours." Journal of International Medical Research 37, no. 4 (August 2009): 1173–78. http://dx.doi.org/10.1177/147323000903700423.
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During operative treatment for ovarian tumours assistance is frequently required to make decisions regarding malignancy status and the extent of the ensuing procedure. Intra-operative frozen section analysis may be useful, provided there is adequate acquaintance with the correlation between using frozen sections and permanent histopathological sections for diagnosis at the institution where the operation is being undertaken. This retrospective study aimed to determine this correlation. Findings from 131 intraoperative frozen sections were compared with the subsequent diagnosis from permanent histopathological sections for women with benign, borderline and malignant ovarian tumours at the Maribor Teaching Hospital (now the University Clinical Centre Maribor) between 1 January 1993 and 31 December 2001. Frozen-section findings corresponded to histopathological findings in 84.7% of cases, with 15.3% false-negative and no false-positive results. For benign, borderline and malignant ovarian tumours, sensitivity was 100.0%, 76.1% and 89.0%, respectively, and specificity was 90.6%, 90.6% and 100.0%, respectively. The majority of errors occurred in diagnosing mucinous borderline tumours. Precise preoperative diagnosis is extremely important in the treatment of ovarian tumours.
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Gidwani, Roopam Kishore, Falguni Jay Goswami, Arpan Mehta, Nirali V. Shah, Shobhana Ashok Prajapati, and Manisha M. Shah. "Frozen Section Diagnosis: Accuracy and Errors; with Emphasis on Reasons for Discordance." Annals of Pathology and Laboratory Medicine 8, no. 2 (February 28, 2021): A33–38. http://dx.doi.org/10.21276/apalm.2932.
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Background: Frozen section is a multistep process involving surgical resection, intraoperative preparation of slides and their microscopic examination. It is important to assess concordant, discordant and deferred diagnosis rates from intra-operative frozen section diagnosis with final diagnosis on paraffin section and to determine the reasons for discordance. An integral part of quality assurance in surgical pathology entails the correlation of intra-operative frozen section diagnosis with final diagnosis on permanent section.
Methods: A retrospective analysis of 117 cases of frozen section biopsy was carried out which were reported in the Histopathology department between July 2007 to June 2012. The correlation between the frozen section diagnosis with final histological diagnosis was performed in order to check the accuracy of the technique. The number and type of discrepancies were compared, causes for the discrepancies were analyzed in order to decrease the avoidable errors and improve on the frozen section diagnoses.
Results: The overall accuracy of frozen section diagnoses over 5years was 90.60% with false positive rate of 0.85%, false negative rate of 6.84% and 1.71% of deferred diagnosis. Sensitivity was 87.69% and Specificity was 98%. The discrepancies were mainly due to the interpretation error, sampling error and technical artefacts.
Conclusions: Gross inspection, sampling by pathologist, frozen section complemented with cytological and histological review and cooperation between consultants can avoid certain limitations and provide rapid, reliable, cost effective information necessary for optimum patient care.
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Yapp, Liam Z., Patrick G. Robinson, Nicholas D. Clement, and Chloe E. H. Scott. "Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?" Current Reviews in Musculoskeletal Medicine 14, no. 6 (December 2021): 361–68. http://dx.doi.org/10.1007/s12178-021-09724-5.
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Abstract Purpose of Review Soft tissue imbalance, presenting as instability or stiffness, is an important cause of revision total knee arthroplasty (TKA). Traditional methods of determining soft tissue balance of the knee lack precision and are not reliable between operators. Use of intra-operative pressure sensors offers the potential to identify and avoid soft tissue imbalance following TKA. This review aims to summarise the literature supporting the clinical indication for the use of intra-articular pressure sensors during TKA. Recent Findings Analytical validation studies suggest that intra-operative pressure sensors demonstrate ‘moderate’ to ‘good’ intra-observer reliability and ‘good’ to ‘excellent’ interobserver reliability throughout the flexion arc. However, there are important errors associated with measurements when devices are used out-with the stated guidelines and clinicians should be aware of the limitations of these devices in isolation. Current evidence regarding patient benefit is conflicting. Despite positive early results, several prospective studies have subsequently failed to demonstrate significant differences in overall survival, satisfaction, and patient-reported outcome measures within 1 year of surgery. Summary Surgeon-defined soft tissue stability appears to be significantly different from the absolute pressures measured by the intra-operative sensor. Whilst it could be argued that this confirms the need for intra-articular sensor guidance in TKA; the optimal ‘target’ balance remains unclear and the relationship with outcome in patients is not determined. Future research should (1) identify a suitable reference standard for comparison; (2) improve the accuracy of the sensor outputs; and (3) demonstrate that sensor-assisted TKA leads to patient benefit in patient-reported outcome measures and/or enhanced implant survival.
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Kordon, Florian, Andreas Maier, Benedict Swartman, Maxim Privalov, Jan Siad El Barbari, and Holger Kunze. "Multi-Stage Platform for (Semi-)Automatic Planning in Reconstructive Orthopedic Surgery." Journal of Imaging 8, no. 4 (April 12, 2022): 108. http://dx.doi.org/10.3390/jimaging8040108.
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Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan’s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols. Here, we develop and analyze a multi-stage algorithm that combines deep learning-based anatomical feature detection and geometric post-processing to enable accurate pre- and intra-operative surgery planning on 2D X-ray images. The algorithm allows granular control over each element of the planning geometry, enabling real-time adjustments directly in the operating room (OR). In the method evaluation of three ligament reconstruction tasks effect on the knee joint, we found high spatial precision in drilling point localization (ε<2.9mm) and low angulation errors for k-wire instrumentation (ε<0.75∘) on 38 diagnostic radiographs. Comparable precision was demonstrated in 15 complex intra-operative trauma cases suffering from strong implant overlap and multi-anatomy exposure. Furthermore, we found that the diverse feature detection tasks can be efficiently solved with a multi-task network topology, improving precision over the single-task case. Our platform will help overcome the limitations of current clinical practice and foster surgical plan generation and adjustment directly in the OR, ultimately motivating the development of novel 2D planning guidelines.
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Faraj, Adnan, Mark Andrews, and Weiguang Li. "Inter and intra-observer errors for postoperative total hip radiographic assessment using computer aided design." Acta Orthopaedica Belgica 87, no. 1 (March 31, 2021): 65–71. http://dx.doi.org/10.52628/87.1.09.
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Plain radiographic assessment of primary total hip arthroplasty following surgery remains to be the commonest radiological assessment. The current paper, studies the accuracy and concordance between observers reviewing these radiographs. A prospective radiographic and medical note review of ten patients who underwent total hip replacement for primary osteoarthritis, with a mean age of 69 years. Early and 6 weeks postoperative x-rays were assessed for hip profile and version profile using computer aided design (CAD) by two observers on two different occasions. The observers were Orthopaedic surgeons who perform arthroplasty of the hip. The results were analyzed statistically. Dimensions, including Femoral offset, medial offset and ilioischial offset showed a high degree of inter- film and intra-film correlation, with inter-class correlation (ICC) over 0.8. Except of the intra-film correlation of ilioischial offset measured on the post- operative films (p=0.067) by the first rater, all the intra and inter film correlation were significantly over the benchmark of 0.6. In terms of stem alignment, cup inclination and cup version, the intra-film correlation by rater n°2 ranges from 0.574 to 0.975 and were significantly over the benchmark of 0.6, except in the case of cup inclination measured on the 6 th? week follow-up ; meanwhile the intra-film correlation by rater n°1 ranges from 0.581 to 0.819 and none were significantly over the benchmark of 0.6. The inter-rater reliability and inter-film correlation showed a dichotomy of results among different dimensions of the measurement. Dimensions of femo- ral offset, medial offset and ilioischial offset showed a substantial degree of reliability in terms of inter-rater reliability, inter-film correlation, and intra-rater/film reliability.
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Su, Chia-Wei, Cheng-Li Lin, and Jing-Jing Fang. "Reconstruction of three-dimensional lumbar vertebrae from biplanar x-rays." Biomedical Physics & Engineering Express 8, no. 1 (November 10, 2021): 015001. http://dx.doi.org/10.1088/2057-1976/ac338c.
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Abstract Objective. Vertebrae models from computer tomographic (CT) imaging are extensively used in image-guided surgical systems to deliver percutaneous orthopaedic operations with minimum risks, but patients may be exposed to excess radiation from the pre-operative CT scans. Generating vertebrae models from intra-operative x-rays for image-guided systems can reduce radiation exposure to the patient, and the surgeons can acquire the vertebrae’s relative positions during the operation; therefore, we proposed a lumbar vertebrae reconstruction method from biplanar x-rays. Approach. Non-stereo-corresponding vertebral landmarks on x-rays were identified as targets for deforming a set of template vertebrae; the deformation was formulated as a minimisation problem, and was solved using the augmented Lagrangian method. Mean surface errors between the models reconstructed using the proposed method and CT scans were measured to evaluate the reconstruction accuracy. Main results. The evaluation yielded mean errors of 1.27 mm and 1.50 mm in in vitro experiments on normal vertebrae and pathological vertebrae, respectively; the outcomes were comparable to other template-based methods. Significance. The proposed method is a viable alternative to provide digital lumbar to be used in image-guided systems, where the models can be used as a visual reference in surgical planning and image-guided applications in operations where the reconstruction error is within the allowable surgical error.
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Ellenbogen, JR, V. Narbad, H. Hasegawa, and R. Selway. "P32 Targeting accuracy of the neuromate robot in DBS implantation for paediatric dystonia." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 3 (February 14, 2019): e33.2-e33. http://dx.doi.org/10.1136/jnnp-2019-abn.105.
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ObjectivesTo quantify the accuracy of DBS electrode implantation for movement disorder in paediatric patients utilising the neuroinspire™ software and neuromate® robot.DesignRetrospective, single-centre, cohort study.SubjectsFifteen patients with dystonia (67% female; median age 11 years, range 8–18 years) underwent intervention since May 2017.MethodsDBS procedures were planned on the neuroinspire™ software and electrodes were implanted using the Renishaw neuromate® robot and Renishaw guide tubes and secured with a dog-bone plate under general anaesthetic. Post-operative CT imaging with the intra-operative O-arm was fused to pre-operative imaging. Planned entry and target coordinates were compared to actual entry and final target coordinates in order to obtain absolute and directional errors in x (medial-lateral), y (anterior-posterior) and z (dorsal-ventral) planes. Euclidean error was calculated for each electrode. Wilcoxon signed-rank test was used to analyse error.ResultsBilateral GPi were targeted and Medtronic DBS systems were implanted for each patient (n=30). Overall median Euclidean error for electrode implantation was 2.13 mm (range, 0.71–4.85; p<0.001). No discrepancy between left- and right-sided electrodes was seen (p=0.346). Absolute errors in x (med 1.25 mm, range 0.10–4.10), y (med 0.80 mm, range 0–2.70) and z (med 1.45 mm, range 0–3.90) planes were individually significant (p<0.001). On overall anterior displacement of leads was observed (med 0.55+0.85 mm, p=0.001) but there was no significant directional bias in x (p=0.219) or z (p=0.077) planes.ConclusionsWe observed an improvement in the discrepancy seen between planned and actual lead location compared to a previously reported series using the Leksell frame in a similar cohort. Addressing possible compounding factors such as drilling techniques and electrode fixation should increase accuracy further. The neuromate® Robot is a reliable and accurate alternative to the Leksell frame.
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Wadhawan, Richa, Sushma Mishra, Niharika Kumari, Suneel Kumar Gupta, Sabanaz Mansuri, and Laishram Memory Devi. "Iatrogenic fracture of right angle and left sub condyle in a 50 year old male: A case report." International Journal of Oral Health Dentistry 7, no. 3 (September 15, 2021): 219–22. http://dx.doi.org/10.18231/j.ijohd.2021.044.
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Iatrogenic errors during exodontias includes trismus, alveolar osteitis, postoperative infection, hemorrhage, oro-antral communication, damage to adjacent teeth, displaced teeth, and fractures.While doing extraction chances of occurrence of fracture of mandible is fortuitously rare, but is under-reported. These fractures could occur in the intra-operative or postoperative period and can cause significant distress to the patient and the practitioner. This case report addresses the incidence of mandibular fracture in a 50-year-old male and various surgical treatment modalities and ways of prevention are discussed.
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Gilley, R. S., F. S. Shofer, A. S. Kapatkin, and M. S. Bergh. "Complications and radiographic findings following cemented total hip replacement." Veterinary and Comparative Orthopaedics and Traumatology 19, no. 03 (2006): 172–79. http://dx.doi.org/10.1055/s-0038-1632994.
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SummaryCemented total hip replacement (cTHR) is commonly performed to treat intractable coxofemoral pain in dogs. While owners generally perceive a good outcome after the procedure, the longevity of the implant may be limited by complications such as infection and aseptic loosening. The objective of this retrospective study was to identify the prevalence of complications and radiographic changes following cTHR, and to identify factors that may predispose to a need for revision surgery. Medical records and radiographs from 97 dogs that underwent cTHR were evaluated for signalment, preoperative degree of osteoarthritis, technical errors, intra-operative culture results, and the post-operative radiographic appearance of the implant. The complications occurring in the intra-operative and short-term (<eight week) periods, and the radiographic appearance of the implant in the long-term (>eight week) time period were recorded. Mean (±SD) follow-up time was 1.1 ± 1.6 years (range: 0–7.7 years). Seven dogs had a short-term complication and a revision surgery was performed in eleven dogs. Osseous or cement changes were radiographically detectable in the majority of cTHR. Eccentric positioning of the femoral stem and the presence of radiolucent lines at the femoral cement-bone interface were positively associated with the occurrence of revision surgery. The clinical significance of the periprosthetic radiographic changes is unclear and further investigation is warranted.
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Kompella, Gayatri, Jeevakala Singarayan, Maria Antico, Fumio Sasazawa, Takeda Yu, Keerthi Ram, Ajay K. Pandey, Davide Fontanarosa, and Mohanasankar Sivaprakasam. "Automatic 3D MRI-Ultrasound Registration for Image Guided Arthroscopy." Applied Sciences 12, no. 11 (May 28, 2022): 5488. http://dx.doi.org/10.3390/app12115488.
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Registration of partial view intra-operative ultrasound (US) to pre-operative MRI is an essential step in image-guided minimally invasive surgery. In this paper, we present an automatic, landmark-free 3D multimodal registration of pre-operative MRI to 4D US (high-refresh-rate 3D-US) for enabling guidance in knee arthroscopy. We focus on the problem of initializing registration in the case of partial views. The proposed method utilizes a pre-initialization step of using the automatically segmented structures from both modalities to achieve a global geometric initialization. This is followed by computing distance maps of the procured segmentations for registration in the distance space. Following that, the final local refinement between the MRI-US volumes is achieved using the LC2 (Linear correlation of linear combination) metric. The method is evaluated on 11 cases spanning six subjects, with four levels of knee flexion. A best-case error of 1.41 mm and 2.34∘ and an average registration error of 3.45 mm and 7.76∘ is achieved in translation and rotation, respectively. An inter-observer variability study is performed, and a mean difference of 4.41 mm and 7.77∘ is reported. The errors obtained through the developed registration algorithm and inter-observer difference values are found to be comparable. We have shown that the proposed algorithm is simple, robust and allows for the automatic global registration of 3D US and MRI that can enable US based image guidance in minimally invasive procedures.
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Mackenzie, Colin F., Guinevere Granite, Kristy Pugh, Hegang Chen, Sharon M. Henry, Samuel A. Tisherman, Babak Sarani, and Stacy Shackelford. "Can Surgeons Making Repeated and Persistent Intra-Operative Trauma Surgical Skill Errors be Identified to Enable Remedial Training Intervention?" Journal of the American College of Surgeons 223, no. 4 (October 2016): e176-e177. http://dx.doi.org/10.1016/j.jamcollsurg.2016.08.448.
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Kennedy-Metz, Lauren R., Roger D. Dias, Annette M. Phillips, Alexander Shapeton, Suzana Zorca, Kay B. Leissner, and Marco A. Zenati. "Prevalence of Surgical Flow Disruptions Across Intra-operative High- and Low-Workload Phases in Cardiac Surgery." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 10, no. 1 (June 2021): 263–66. http://dx.doi.org/10.1177/2327857921101245.
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While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to be explored. Recent evidence suggests that preventable surgical errors often have a cognitive basis, warranting investigation into the association between SFDs and workload. This study aimed to characterize SFDs according to auditory and cognitive domains and further to compare the frequency and nature of SFDs within periods of high team cognitive workload and low team cognitive workload. Overall, the presence of cognitive distractions was associated more with high team cognitive workload states, while the frequency of auditory distractions was significantly higher during periods of low team cognitive workload states. Future work should consider the types, frequency, and sources of SFDs as well as their impact on surgical procedures and outcomes in order to devise appropriate methods to mitigate or manage potential disruptions to surgical workflow.
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Mansur, Dil Islam, P. Shrestha, and S. Maskey. "Morphological Variations in Human Liver: A Cadaveric Study." Nepal Medical College Journal 21, no. 4 (December 31, 2019): 249–53. http://dx.doi.org/10.3126/nmcj.v21i4.27612.
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The variations of liver like the accessory fissures and lobes are a potential source of diagnostic errors. The knowledge in the variations may help in diagnosis, treatment planning and minimize the risk of post operative complications. The present study was aimed to observe the morphological variations of livers. The study was done in 70 formalin fixed human livers and was observed for morphological variations. The present study concluded the normal morphology of liver was in 54.28% and anomalies in 45.71% of liver. The most common anomalies were accessory fissures which were found in 32.86% of livers. The second common anomalies were absence or incomplete fissure for ligamentum teres in 15.71% of livers. Then the enlarged papillary process was found in 11.43%, short gall bladder was in 10% and elongated left lobe was in 7.14%. The knowledge of normal and variant liver may contribute to the understanding of the liver disease and to achieve correct preoperative diagnosis; and to avoid intra-operative complications.
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Faddeev, D. I. "Complication rate of long bone fractures treated by early stable internal and trans-osseous osteosynthesis." N.N. Priorov Journal of Traumatology and Orthopedics 4, no. 1 (January 15, 1997): 18–23. http://dx.doi.org/10.17816/vto105698.
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Complications occurring in 94 (24.1%) of 390 operative osteisynthesis were analysed. There were 284 patients with composite (115) and combined fractures of long bones. Complications occurred during recovery in 54 (23.6%) cases of transosseous osteosynthesis and in 40 (24.8%) cases of internal osteosynthesis. Intra-operative complications occurred in 4 cases due to technical errors, e.g. further comminution or vascular injury. Postoperative complications occurred in 7 cases due to inappropriate choice of fixation device, e.g. loss of reduction or fication failure. Postoperative infections predominantly involved the femur and tibia (60.6%). The final outcome was not influenced by local pin tract infection involving either skin, bone or both. There were 15 cases with general complications, e.g. pneumonia, thromboembolism, and decubiti; and 12 with local complications, e.g. toxidermia and marginal wound necrosis. All general complications were associated with restricted patient mobility and were observed 3 times more frequently (6.2%) with internal osteosynthesis than with transosseous osteosynthesis (2.2%). Careful attention to technique will help minimize the complication rate of osteosynthesis.
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Torres, P. M. B., P. J. S. Gonçalves, and J. M. M. Martins. "Robotic motion compensation for bone movement, using ultrasound images." Industrial Robot: An International Journal 42, no. 5 (August 17, 2015): 466–74. http://dx.doi.org/10.1108/ir-12-2014-0435.
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Purpose – The purpose of this paper is to present a robotic motion compensation system, using ultrasound images, to assist orthopedic surgery. The robotic system can compensate for femur movements during bone drilling procedures. Although it may have other applications, the system was thought to be used in hip resurfacing (HR) prosthesis surgery to implant the initial guide tool. The system requires no fiducial markers implanted in the patient, by using only non-invasive ultrasound images. Design/methodology/approach – The femur location in the operating room is obtained by processing ultrasound (USA) and computer tomography (CT) images, obtained, respectively, in the intra-operative and pre-operative scenarios. During surgery, the bone position and orientation is obtained by registration of USA and CT three-dimensional (3D) point clouds, using an optical measurement system and also passive markers attached to the USA probe and to the drill. The system description, image processing, calibration procedures and results with simulated and real experiments are presented and described to illustrate the system in operation. Findings – The robotic system can compensate for femur movements, during bone drilling procedures. In most experiments, the update was always validated, with errors of 2 mm/4°. Originality/value – The navigation system is based entirely on the information extracted from images obtained from CT pre-operatively and USA intra-operatively. Contrary to current surgical systems, it does not use any type of implant in the bone to track the femur movements.
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RAMPRASAD, P., H. C. NAGARAJ, M. K. PARASURAM, and M. SHUBHA. "MULTI RESOLUTION BASED IMAGE REGISTRATION TECHNIQUE FOR MATCHING DENTAL X-RAYS." Journal of Mechanics in Medicine and Biology 09, no. 04 (December 2009): 621–32. http://dx.doi.org/10.1142/s0219519409003085.
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This paper presents a new technique to assess the bone formation after periapical dental surgery. The proposed technique consists of two main stages: image registration and spectral subtraction stages. Image registration is used to avoid projection errors produced due to nonstandardization of X-ray scanners. Wavelet coefficients are used instead of grey values for registering the images. Coarse to fine strategy with four levels of resolutions is used to speed up the process. The second stage is the spectral subtraction stage. It is used to yield the difference image between pre- and post-operative images which represents the bone gain or bone loss with light and dark areas, respectively. Algorithm has been applied on a number of pre- and post-surgery intra oral periapical (IOP) dental X-ray images. Mean and root mean square error (RMSE) are computed to assess the quality of registration technique. The technique presented here is compared with grey level based method; results show that proposed technique outperforms conventional grey level method based on dyadic sampling.
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Hakobyan, G., L. Essayain, G. Khachatryan, A. Khachatryan, T. Kijomova, L. Gilamiryan, and I. Gazazyan. "Evaluation of the effectiveness of dental implants with the use of 3D programming software and surgical guided." SUCHASNA STOMATOLOHIYA 103, no. 4 (2020): 38–44. http://dx.doi.org/10.33295/1992-576x-2020-4-38.
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Background. The use of modern digital technologies significantly changes the classical approaches to planning and conducting dental implantation. The whole process can be accomplished performed thus, so that the ideal placement of the implant can be achieved without the injured anatomical structure. Purpose. To evaluate the effectiveness of dental implant placement with the use of 3D-modeling and surgical guided. Materials and methods. A total of 148 patients with ridge defects in age group were selected for the study. All patients had a partially or totally edentulous. Computer scans, three-dimensional computer modeling were used to plan operations. 2 Patient groups were formed to evaluate the effectiveness of treatment using 3D modeling and surgical guided. Patients were included in group I, at the planning stage only a CT scan was used, Group II included patients who underwent a CT scan, 3D computer modeling (3 Shape Implant Studio) during the planning phase, and surgical guided (were fabricated with a desktop 3D printer Stratasys), were used in the surgical phase, the dental defect was restored with the with implant insertion. Results. In Group I, intraoperative or immediate post-operative complications were noted (errors in the position, inclination), anatomical risk structures were invaded, after 3 years producing a survival rate of 96.2 %. In Group II, no intra-operative or immediate post-operative complications were noted (no errors in the position, inclination,), no anatomical risk structures, after 3 years producing a survival rate of 97.6 %. Conclusion. The 3D modeling method and the use of surgical guided for dental implantation significantly risk the complications. Implant placement through the precision surgical guide is more accurate than freehand placement into the osteotomy, the guides allow installation of dental implants in the most optimal position for future prosthetic work, depth, and inclination.
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Yeo, Cheng Hong, A. Jariwala, N. Pourgiezis, and A. Pillai. "Assessing the Accuracy of Bone Resection by Cutting Blocks in Patient-Specific Total Knee Replacements." ISRN Orthopedics 2012 (May 20, 2012): 1–4. http://dx.doi.org/10.5402/2012/509750.
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Introduction. The key to a successful total knee arthroplasty (TKA) is the restoration of the mechanical axis with balanced flexion and extension gaps. Patient-specific cutting block technique has been the latest development in total knee arthroplasty. This technique uses a magnetic resonance image (MRI) of the patient's symptomatic knee to create bone models and cutting jigs. This study was designed to evaluate the intraoperative accuracy of the patient-specific cutting block as compared to the preoperative template. Methods. Visionaire (Smith and Nephew, Genesis 2 Knee Arthroplasty) patient-specific TKA was used in all patients. An independent research officer was responsible for measuring all the resected articular surfaces of femur and tibia during surgery and compared it to the cutting block manufactured according to the preoperative template. Seven different measurements from each patient were obtained; four different measurements from the femur and three from the tibia were recorded. The differences between the actual resections made intraoperatively, as compared to the original pre-operative templates, were noted as the error. The surgical team was blinded to the measurements of the resections and the calculations of the errors. Results. Twenty-six Visionaire patient-specific TKA were included in the study. A total of 182 readings of bone resections made intraoperatively (seven for each patient). Eighty five percent of all collected readings were below the error margin of ≤1.5 mm. Size of resection had no effect on the error margin. All patients had satisfactory post-operative alignment, and at discharge all 26 patients achieved more than 90° of knee flexion. Conclusion. This observational study provides evidence that patient-specific TKA is comparable to other forms of TKA and may have some distinct advantages. In addition, we have shown that the cutting blocks are able to consistently deliver accurate cuts that are reproducible. We recommend intra-operative measurement of the bone resection and its comparison with the cutting block as a routine surgical step to confirm the MRI scan data, block placement, and instant validation of the bony resection before implant placement.
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Sreedharan, Sechachalam, Muhammad Farhan Mohd Fadil, and Winston Shang Rong Lim. "INTRA-OPERATIVE CORRECTION OF VOLAR TILT OF DISTAL RADIUS FRACTURES USING VOLAR LOCKING PLATE AS REDUCTION TOOL: REVIEW OF 24 CASES." Hand Surgery 19, no. 03 (January 2014): 363–68. http://dx.doi.org/10.1142/s0218810414500282.
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In surgical fixation of distal radius fractures with metaphyseal comminution, volar tilt can be restored using an anatomical volar locking plate as a reduction tool. The purpose of our study is to assess the degree of over or under correction of volar tilt that can result with our 'lift' technique and to determine the ratio between theoretical and actual angular correction. We retrospectively reviewed 24 patients who underwent distal radius fracture fixation using this technique and assessed intra-operative radiographs for parameters including pre-'lift' and post-'lift' volar tilt and pre-'lift' plate-shaft angles. The ratio between actual angular correction and theoretical angular correction was calculated. The 'lift' technique is found to be reliable in restoring volar tilt in most fractures. Over- or under-correction does occur due to errors in visual estimation and actual angular correction is generally less than the theoretical angular correction.
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Antwi-Adjei, Ellen Konadu, Emmanuel Owusu, Emmanuel Kobia-Acquah, Emmanuella Esi Dadzie, Emmanuel Anarfi, and Seth Wanye. "Evaluation of postoperative refractive error correction after cataract surgery." PLOS ONE 16, no. 6 (June 17, 2021): e0252787. http://dx.doi.org/10.1371/journal.pone.0252787.
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Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40–100) who reported to an eye hospital in Ghana from 2013–2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient demographics, type of surgery, intra-ocular lens (PCIOL) power, availability of biometry, postoperative refraction outcomes, pre- and postoperative visual acuity were analyzed. Data of two hundred and thirteen eyes of 190 patients who met the inclusion criteria were analyzed. Descriptive analysis and Chi-square test were carried out to determine the mean, median, standard deviation and relevant associations. The mean ± SD age was 67.21±12.2 years (51.2% were females). Small Incision Cataract Surgery (99.5%) with 100% IOL implants was the main cataract surgery procedure in this study. Pre-operative biometry was performed for 38.9% of all patients on their first eye surgery and 41.5% for second eye surgeries. About 71% eyes in this study were blind (presenting VA<3/60) before surgery; 40.4% had post-operative VA <3/60. Pre-existing ocular comorbidities discovered post- surgery, attributed to suboptimal visual outcomes. More than half (55.3%) of patients did not undergo postoperative refraction due to loss to follow-up. Year of surgery (p = .017), follow up visits< 2months (p < .0001) and discovered comorbidity post-surgery (p = .035) were the factors significantly associated with postoperative refraction. Myopia and compound myopic astigmatism were the dominant refractive error outcomes. The timing of post-operative refraction had a significant effect on postoperative refraction done. These findings indicate a clinically meaningful significance between completion of postoperative care and postoperative refraction done. Consequently, with settings in most developing countries, where less biometry is done, it is appropriate that post-operative refractive services are encouraged and done earlier to enhance the patients’ expectations while increasing cataract surgery patronage.
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Малеев, Yu Maleev, Черных, A. Chernykh, Шевцов, and A. Shevtsov. "Clinical Anatomy of the Parathyroid Glands. New Data and Approaches." Journal of New Medical Technologies 20, no. 4 (December 20, 2013): 86–92. http://dx.doi.org/10.12737/2737.
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New approaches to the assessment of clinical anatomy of the parathyroid glands were developed. The obtained new data allow improving the quality of planning and carrying out operations on the thyroid and parathyroid glands, to reduce the risk of errors in diagnosis and intra-operative and post-operative complications. 220 corpses and 82 patients after surgery on the thyroid gland pathology were examined. In morphological material 4 or 5 of the parathyroid glands were found.
Size parathyroid glands was 0,70x0,43x0,30 cm, volume - 0,0531+0,0016 cm3, and the total volume of parathyroid tissue in one case - 0,1903±0,0075 cm3. Maximum size parathyroid glands without pathologies are: 1,4x1,0x1,0 cm. On the basis of the ratio of integral indexes forms parathyroid glands were determined. The authors identified three periods of the postnatal development of human parathyroid glands: maximum growth (up to 35 years), the relative stability (36-65 years), involution (over 65 years). The revealed regularities topography are different for the «upper» of the parathyroid glands(parathyroid glands IV), located in the zones 2-3, 3 and 3-4 and to «lower» glands (parathyroid glands III) at the level of 1, 1-2, 2, 4, 5 or 5 zones. Five common variants of parathyroid glands different sizes and shapes in relation to the thyroid gland were identified. It was established that studied nosologic forms of diseases of the thyroid doesn´t affect the linear size and topography of the parathyroid glands in the frontal plane. New data on the clinical anatomy of the parathyroid glands allow to reduce the cases of intra-and postoperative complications in operations at the front of the neck.
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Polistena, Andrea, Pierpaolo Di Lorenzo, Alessandro Sanguinetti, Claudio Buccelli, Giovanni Conzo, Adelaide Conti, Massimo Niola, and Nicola Avenia. "Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation." Open Medicine 11, no. 1 (January 1, 2016): 298–306. http://dx.doi.org/10.1515/med-2016-0058.
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AbstractAim of the present paper is the review of the principal complications associated to endocrine neck surgery considering how expertise, full adoption of guidelines, appropriate technology and proper informed consent may limit the medicolegal claims at the light of the incoming new regulation of the medical professional legal responsibility. A literature search, using the Medline/PubMed database for full-length papers, was used. Postoperative recurrent laryngeal nerve (RLN) palsy and hypoparathy-roidism remain the principal causes of surgical malpractice claims . In the procedure of neck lymphadenctomy intra-operative haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be observed and can be source of claims. After many years of increased medicolegal litigations, the Italian government is proposing a drastic change in the regulations of supposed medical malpractice in order to guarantee the patient’s right to a safe treatment and in the meantime to defend clinicians from often unmotivated and prejudicial legal cases. Surgical errors and complications in neck surgery are a relevant clinical issue. Only the combination of surgical and clinical expertise, application of guidelines, appropriate technology and a routinely use of specific informed consent can contain potential medicolegal implications.
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Matthies, Ashley K., Johann Henckel, John A. Skinner, and Alister J. Hart. "A Retrieval Analysis of Explanted Durom Metal-On-Metal Hip Arthroplasties." HIP International 21, no. 6 (June 12, 2011): 724–31. http://dx.doi.org/10.5301/hip.2011.8885.
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Given the recent reports of high failure rates, an improved understanding of the mechanism of failure of large diameter metal-on-metal hip arthroplasties is essential. We present clinical data and tribological analysis of a consecutive series of 74 failed large diameter metal-on-metal hips, comparing the Durom (Zimmer) with the Birmingham hip resurfacing (BHR) (Smith and Nephew). We retrospectively analysed pre-, intra-, and post-operative clinical data and measured the linear wear and component form of the explanted components using a roundness measuring machine. A significantly higher proportion of hips in the Durom group failed as a result of acetabular loosening (p=0.001) and this was supported by evidence of reduced bone in-growth on the backside of the cup. Comparison of roundness measurement revealed that the Durom hip was significantly lower wearing than the BHR (p<0.05) but the Durom femoral components were subject to significantly greater form errors (p<0.001), the pole of the head being flattened by up to 31 microns. Although the Durom hip is low wearing, reduced sphericity of the femoral component may have resulted in equatorial bearing, leading to an increased frictional torque at the cup-bone interface, preventing bone in-growth, and culminating in acetabular loosening. This supports recent clinical findings of high revision rates as a result of acetabular loosening for the Durom metal-on-metal hip system.
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Ribakova, Anna, and Liana Deklava. "Assessment of non-technical skills of operating room nurses." SHS Web of Conferences 51 (2018): 02011. http://dx.doi.org/10.1051/shsconf/20185102011.
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Training of non-technical skills helps to achieve reduction of human errors that could contribute to safety of patients. For assessment of non-technical skills of Operating Room (OR) nurses, researchers of the University of Aberdeen developed intra-operative work organization protocol for observation of non-technical behaviour. This system includes taxonomy of non-technical skills, definitions, desirable and adverse behavioural markers, and Likert scale for behavioural assessment. The objective of this research is to assess non-technical skills of OR nurses in work environment and compare the findings with OR nurses self-assessment of non-technical skills. The study involved 15 interviews with OR nurses in sterile position (scrub nurses) and 15 observations of their work in four hospitals. Providing self-assessment, OR nurses note a tendency to minimal communication. In practice, nurses often show good ability to think analytically, to predict events and needs and are able to act decisively during surgery. OR nurses in Latvia partially associate their work with non-technical skills, however in practice these skills are used, and they were relatively highly valued during the study. Insufficient self-assessment of such skills of nurses as cooperation in performance of physical tasks, promotion of personnel safety and decisive action, indicates the need for development of scrub nurse's work standards with clearly defined area of responsibility and duties.
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Jacobs, Jeffrey P. "Introduction – Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease." Cardiology in the Young 18, S2 (December 2008): 1–37. http://dx.doi.org/10.1017/s104795110800334x.
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AbstractThe Multi-Societal Database Committee for Pediatric and Congenital Heart Disease was established in 2005 with the goal of providing the infrastructure, spanning geographical and subspecialty boundaries, for collaboration between health care professionals interested in the analysis of outcomes of treatments provided to patients with congenital cardiac disease, with the ultimate aim of improvement in the quality of care provided to these patients. The purpose of these collaborative efforts is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research and community service. This manuscript provides the Introduction to the 2008 Supplement to Cardiology in the Young titled: “Databases and The Assessment of Complications associated with the Treatment of Patients with Congenital Cardiac Disease”. This Supplement was prepared by The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease.The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease offers the following definition of the term “Complication”: “A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.”The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease offers the following definition of the term “Adverse Event”: “An adverse event is a complication that is associated with a healthcare intervention and is associated with suboptimal outcome. Adverse events represent a subset of complications. Not all medical errors result in an adverse event; the administration of an incorrect dose of a medication is a medical error, but it does not always result in an adverse event. Similarly, not all adverse events are the result of medical error. A child may develop pneumonia after an atrial septal defect repair despite intra- and peri-operative management that is free of error. Complications of the underlying disease state, which are not related to a medical intervention, are not adverse events. For example, a patient who presents for medical care with metastatic lung cancer has already developed a complication (Metastatic spread) of the primary lung cancer without any healthcare intervention. Furthermore, complications not associated with suboptimal outcome or harm are not adverse events and are known as no harm events. The patient who receives an incorrect dose of a medication without harm has experienced a no harm event, but not an adverse event.”Based on the above definitions, it is apparent that The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease has taken an inclusive approach to defining the universe of complications. Complications may or may not be associated with healthcare intervention and may or may not be associated with suboptimal outcome. Meanwhile, adverse events must be associated with healthcare intervention and must be associated with suboptimal outcome.
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Lingam, Gopal, Alok C. Sen, Vijaya Lingam, Muna Bhende, Tapas Ranjan Padhi, and Su Xinyi. "Ocular coloboma—a comprehensive review for the clinician." Eye 35, no. 8 (March 21, 2021): 2086–109. http://dx.doi.org/10.1038/s41433-021-01501-5.
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AbstractTypical ocular coloboma is caused by defective closure of the embryonal fissure. The occurrence of coloboma can be sporadic, hereditary (known or unknown gene defects) or associated with chromosomal abnormalities. Ocular colobomata are more often associated with systemic abnormalities when caused by chromosomal abnormalities. The ocular manifestations vary widely. At one extreme, the eye is hardly recognisable and non-functional—having been compressed by an orbital cyst, while at the other, one finds minimalistic involvement that hardly affects the structure and function of the eye. In the fundus, the variability involves the size of the coloboma (anteroposterior and transverse extent) and the involvement of the optic disc and fovea. The visual acuity is affected when coloboma involves disc and fovea, or is complicated by occurrence of retinal detachment, choroidal neovascular membrane, cataract, amblyopia due to uncorrected refractive errors, etc. While the basic birth anomaly cannot be corrected, most of the complications listed above are correctable to a great extent. Current day surgical management of coloboma-related retinal detachments has evolved to yield consistently good results. Cataract surgery in these eyes can pose a challenge due to a combination of microphthalmos and relatively hard lenses, resulting in increased risk of intra-operative complications. Prophylactic laser retinopexy to the border of choroidal coloboma appears to be an attractive option for reducing risk of coloboma-related retinal detachment. However, a majority of the eyes have the optic disc within the choroidal coloboma, thus making it difficult to safely administer a complete treatment.
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Weinrauch, P. "Intra-Operative Error during Austin Moore Hemiarthroplasty." Journal of Orthopaedic Surgery 14, no. 3 (December 2006): 249–52. http://dx.doi.org/10.1177/230949900601400304.
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Pelypenko, O., and O. Kovalov. "ANALYSIS OF THE CAUSES OF MECHANICAL COMPLICATIONS AFTER OSTEOSYNTHESIS OF THE LIMBS." Problems of traumatology and osteosynthesis, no. 1(19) (December 10, 2020): 47–59. http://dx.doi.org/10.51309/2411-6858-2020-19-1-47-59.
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Summary. The complications, reported most frequently by physicians are: additions of an infection, impaired fracture union processes, the occurrence of persistent joint contractures, especially after intra-articular fractures. Mechanical-related complications associated with bone-fixing devices are of particular importance. The information mechanical complications in the literature is rather controversial. Particularly debatable is the identification of any specific backgrounds of these complications. Virtually no attention is paid to the behavioral or social aspects of the issue, and the quality of the rehabilitation regime. Objective. Analysis of the background of the complications after surgical treatment, associated with mechanical factors, and identification of the means able to prevent them. Material and methods. The results of treatment of 36 patients operated on for fractures of their extremities, who had complications related to the inadequate mechanical fixation of their broken bones. The onset of complications ranged from 5 days to 1 year from the date of surgery. All patients were divided into 2 groups: Group I (iatrogenic) - 10 patients with iatrogenic complications; Group II (patient-dependent) - 26 patients with clearly identified patient-dependent disorders. Results. There were 15 fractures of a retainer (or its elements) and 21 cases of migration or deformation of structures. The most problematic segment was the proximal thigh, which, in our opinion, has a clear age dependence. Analyzing the errors of surgical treatment (group I), we have assumed that they could be prevented by the timely correction of postoperative complications. The prescribed treatment regimen was violated in 72,2% of cases (group II). 13 patients (50%) reported a repeated trauma in the early post-operative period. Conclusions. Prevention of mechanically-induced complications should be based on the adherence to surgical protocols, dynamic observation of the patients in the post-operation period through tight relations with the outpatient unit, considering both somatic and psychological criteria, and timely correction of the treatment regimen.
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Flanigan, David C., Joshua Scott Everhart, Alex DiBartola, James Moley, Devendra Dusane, Robert A. Magnussen, Christopher C. Kaeding, and Paul Stoodley. "Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions." Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (July 1, 2018): 2325967118S0006. http://dx.doi.org/10.1177/2325967118s00067.
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Objectives: Technical errors, traumatic re-injury, and biologic failure all play a potential role in failure after ACL reconstruction (ACLR). Recent work has demonstrated the frequent presence of biofilms on failed ACLR grafts. Tunnel widening is commonly observed upon presentation for revision ACLR but the relationship between biofilm presence and tunnel widening is unclear. The purpose of this study is to determine whether tunnel widening is associated with bacterial biofilms in failed ACL reconstructions. Methods: 34 consecutive revision ACLR cases and 5 primary ACLR controls were included. Tissue biopsies were obtained from tibial, femoral, and intra-articular segments of revision cases and torn native ligament as well as excess hamstring graft after fixation from primary ACLR controls. Clinical cultures as well as PCR for bacterial DNA with a universal primer were obtained on all patients. Fluorescence microscopy was used to visually confirm presence of biofilm. No patients had clinical signs of infection. Tunnel diameters were measured on pre-operative 3-dimensional imaging. Results: Bacterial DNA was present in 87% of cases and 20% of controls. Cultures were only positive (coagulase negative staphyloccous sp.) in one revision case, the widest measured tunnel diameters were in this same case (20.1 mm for the tibial tunnel and 16.9 mm for the femoral tunnel) Bacterial DNA was positively associated with wider femoral tunnels (median 10.6 mm with detectable bacterial DNA, median 7.6 mm without detectable bacterial DNA; p=0.04 Wilcoxon rank-sum). There was a trend toward higher rates of bacterial DNA in tibial tunnels with diameters greater than 12.5 mm (LR chi square p= 0.12). Fluorescence microscopy confirmed presence of staphylococcal biofilms adherent to the soft tissue graft surface (Figure 1) as well as inert fixation material including monofilament suture, braided suture, and PEEK and metal interference screws. Conclusion: Bacterial biofilms are commonly encountered on failed ACLR grafts. These biofilms do not cause clinically apparent infection symptoms but are associated with tunnel widening and may contribute to biologic failure.
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Berry, E., M. Cuppone, S. Porada, P. A. Millner, A. Rao, N. Chiverton, and B. B. Seedhom. "Personalised image-based templates for intra-operative guidance." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 219, no. 2 (February 1, 2005): 111–18. http://dx.doi.org/10.1243/095441105x9273.
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The high rate of unplanned perforation, poor fixation, and nerve injury with freehand pedicle screw insertion has led to the use of image-guided navigation systems. Although these improve accuracy, they have several drawbacks that could be overcome by using image-based drilling guide templates. The accuracy of such templates was tested in a cadaveric study of screw placement in the lumbar, thoracic, and cervical regions of the spine. The dimensional stability with autoclaving of duraform polyamide, to be used for manufacturing the guides, was first determined using test specimens. Computed tomography (CT) images were acquired of 4 cadaveric spines, and placement of 4 cervical, 32 thoracic, and 14 lumbar screws was planned. Eighteen personalized drilling guide templates, in four different designs, were built. Orthopaedic surgeons experienced in the freehand techniques used the templates. CT images were acquired to assess placement position with respect to the pedicle. Duraform polyamide was found to be unaffected by sterilization. Two of the template designs facilitated the placement of 20/20 screws without error. Templates can lead to successful screw placement, even in small pedicles, providing their design is optimized for the application area, e.g. with enhanced rotational stabilization.
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Farnia, Parastoo, Bahador Makkiabadi, Maysam Alimohamadi, Ebrahim Najafzadeh, Maryam Basij, Yan Yan, Mohammad Mehrmohammadi, and Alireza Ahmadian. "Photoacoustic-MR Image Registration Based on a Co-Sparse Analysis Model to Compensate for Brain Shift." Sensors 22, no. 6 (March 21, 2022): 2399. http://dx.doi.org/10.3390/s22062399.
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Brain shift is an important obstacle to the application of image guidance during neurosurgical interventions. There has been a growing interest in intra-operative imaging to update the image-guided surgery systems. However, due to the innate limitations of the current imaging modalities, accurate brain shift compensation continues to be a challenging task. In this study, the application of intra-operative photoacoustic imaging and registration of the intra-operative photoacoustic with pre-operative MR images are proposed to compensate for brain deformation. Finding a satisfactory registration method is challenging due to the unpredictable nature of brain deformation. In this study, the co-sparse analysis model is proposed for photoacoustic-MR image registration, which can capture the interdependency of the two modalities. The proposed algorithm works based on the minimization of mapping transform via a pair of analysis operators that are learned by the alternating direction method of multipliers. The method was evaluated using an experimental phantom and ex vivo data obtained from a mouse brain. The results of the phantom data show about 63% improvement in target registration error in comparison with the commonly used normalized mutual information method. The results proved that intra-operative photoacoustic images could become a promising tool when the brain shift invalidates pre-operative MRI.
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Hickey, E. J., Y. Nosikova, E. Pham-Hung, M. Gritti, C. A. Caldarone, S. Schwartz, A. Redington, and G. S. Van Arsdell. "AVIATION “THREAT AND ERROR MODEL” IN CONGENITAL CARDIOVASCULAR SURGERY: INEFFECTIVE INTRA-OPERATIVE ERROR RESCUE LEADS TO DANGEROUS ERROR CYCLES." Canadian Journal of Cardiology 30, no. 10 (October 2014): S172. http://dx.doi.org/10.1016/j.cjca.2014.07.268.
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Chandra, Jaideep, and Raj Kumar KC. "Cystic Meningiomas: A Radiological and Histological Study and Pre Operative Diagnostic Errors." Journal of Universal College of Medical Sciences 7, no. 1 (June 30, 2019): 22–26. http://dx.doi.org/10.3126/jucms.v7i1.24681.
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INTRODUCTION: Meningiomas are solid neoplasms, cysts are extremely rare, diagnostically elusive, and behave differently. Therefore, a study was initiated comparing our cases with various series. This is the second largest series so far reported. We tried to hypothesize how to eliminate diagnostic errors in this study, while few interesting points were discovered.
MATERIAL AND METHODS: All meningiomas operated in the last seventeen years were reviewed. It was a retrospective study. Diagnostic errors, clinical behaviour and histopathology were reviewed. Planning of surgery and prognostication demands that the diagnosis be established pre-operatively and since these tumours may mimic other brain tumour types on radiology , factors that may lead to better diagnostic accuracy were tried to be established. Categorization of the tumours with different cyst types according to various classifications was done. The follow up period was two months to ten years.
RESULTS: Out of 530 meningiomas, we found 20 with cystic changes.. There mean age was 47.5 years. The commonest symptoms were raised intra cranial pressure, hemiparesis, memory loss, behavioral changes, vision loss, papilloedem and cranial nerve palsies. The most common histological variety was meningothelial meningioma. The incidence of high grade or malignant tumors was 30 %. Based on radiology, the highest diagnostic accuracy was achieved in 62.5% cases only.
CONCLUSION: Cystic meningiomas continue to pose diagnostic challenges. Multi-planar contrast magnetic resonance imaging (MRI) will help in establishing accurate diagnosis, it reveals cysts missed on computed tomography (CT) scans. This would lead to accurate prognostication and better surgical planning with the aim of preventing recurrences.
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Pugh, Carla M., Elaine R. Cohen, Katherine E. Law, Anne-Lise Maag, Jacob A. Greenberg, Thomas Yen, Caprice C. Greenberg, and Douglas Wiegmann. "Resident readiness for independence: an analysis of intra-operative error management in a simulated setting." Journal of the American College of Surgeons 219, no. 4 (October 2014): e39. http://dx.doi.org/10.1016/j.jamcollsurg.2014.07.489.
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Morrison, M. A., F. Tam, M. M. Garavaglia, G. M. T. Hare, M. D. Cusimano, T. A. Schweizer, S. Das, and S. J. Graham. "PS2 - 196 Investigating the Spatial Agreement Between Pre-Operative Functional MRI and Intra-Operative Direct Cortical Stimulation." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, S4 (October 2016): S17. http://dx.doi.org/10.1017/cjn.2016.378.
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Pre-operative functional magnetic resonance imaging (fMRI) has emerged as valuable clinical tool to help surgically manage patients diagnosed with brain tumours. Surgical decision-making may be significantly improved through the provision of fMRI, however its clinical usage is contingent on the level of agreement with direct cortical stimulation (DCS). While previous studies have been undertaken to investigate the spatial agreement between fMRI and DCS, the influence that various factors may have on fMRI sensitivity and specificity is not fully clear. Thus, in a group of eight brain tumour patients who underwent pre-operative fMRI followed intra-operative DCS during an awake craniotomy procedure, we measured the agreement between the two brain mapping techniques looking at the influence of behavioural task, statistical threshold, and task standardization. Results: There were significant differences between motor and language mapping, where agreement was better for the former. Sensitivity and specificity shared an inverse relationship with increasing fMRI threshold, and were significantly reduced in the case where tasks were not standardized. Lastly, false positive occurrences were identified as the dominate source of error in comparison to false negative occurrences. Conclusion: Thus, the results from this work suggest that fMRI can predict intraoperative findings with good accuracy, however, sources of variability may significantly reduce the quality of fMRI data at the single-subject level. Neurosurgeons should carefully evaluate fMRI data with these considerations prior to its inclusion in the surgical-decision making process.
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Haklar, Uğur, Ertuğrul Ulusoy, Tayfun Şimşek, and Nuray Terzi. "Are Early Results of Robotic Assisted Medial Unicompartmental Knee Arthroplasty Successful?" Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0013. http://dx.doi.org/10.1177/2325967114s00138.
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Objectives: Robotic surgery studies have been increasing in literature in the past years due to its operative advantages on reducing error and improving functional success in partial knee arthroplasty. Methods: Data were prospectively collected in 21 patients (31 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – January 2014 in our clinic with an average follow-up time of 5.5 months. Clinical outcomes were evaluated with American Knee Society Scoring System. Additionally, intra-operative digitally planned implant positions on the robot’s software were compared with post-operative radiographic component alignment. In the radiographic evaluation; anatomic axis of the tibia was observed in the coronal plane. Tibial posterior slope and flexion angle of the femoral component were observed in the sagittal plane. Results: Pre-operatively 1 patient was scored fair (60 points) and 20 patients were scored poor (mean, 46.6 points) on American Knee Society Scoring System. Post-operatively all 21 patients had excellent knee scores (mean, 99.67 points). Function-wise 7 patients were scored fair (mean, 60 points) and 14 patients were scored poor (mean, 30.7 points) again on American Knee Society Functional Scoring System. Post-operatively all 21 patients exhibited excellent function scores (mean, 99.04 points). In the radiological evaluation, intra-operative robotic analyses were compared with post-operative radiographic alignment. No significant difference was observed statistically (paired t-test, p < 0.05). This comparison is valuable as Lonner, Hernigou, Collier report that mal-alignment by as little as 2° may predispose to implant failures. Conclusion: Robotic assistance greatly improves clinical and functional outcomes and may help prevent implant failures due to surgical error and mal-alignment in partial knee arthroplasty.
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An, Zhou, Honghai Ma, Lilu Liu, Yue Wang, Haojian Lu, Chunlin Zhou, Rong Xiong, and Jian Hu. "Robust Orthogonal-View 2-D/3-D Rigid Registration for Minimally Invasive Surgery." Micromachines 12, no. 7 (July 20, 2021): 844. http://dx.doi.org/10.3390/mi12070844.
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Intra-operative target pose estimation is fundamental in minimally invasive surgery (MIS) to guiding surgical robots. This task can be fulfilled by the 2-D/3-D rigid registration, which aligns the anatomical structures between intra-operative 2-D fluoroscopy and the pre-operative 3-D computed tomography (CT) with annotated target information. Although this technique has been researched for decades, it is still challenging to achieve accuracy, robustness and efficiency simultaneously. In this paper, a novel orthogonal-view 2-D/3-D rigid registration framework is proposed which combines the dense reconstruction based on deep learning and the GPU-accelerated 3-D/3-D rigid registration. First, we employ the X2CT-GAN to reconstruct a target CT from two orthogonal fluoroscopy images. After that, the generated target CT and pre-operative CT are input into the 3-D/3-D rigid registration part, which potentially needs a few iterations to converge the global optima. For further efficiency improvement, we make the 3-D/3-D registration algorithm parallel and apply a GPU to accelerate this part. For evaluation, a novel tool is employed to preprocess the public head CT dataset CQ500 and a CT-DRR dataset is presented as the benchmark. The proposed method achieves 1.65 ± 1.41 mm in mean target registration error(mTRE), 20% in the gross failure rate(GFR) and 1.8 s in running time. Our method outperforms the state-of-the-art methods in most test cases. It is promising to apply the proposed method in localization and nano manipulation of micro surgical robot for highly precise MIS.
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Thomas, Sarina, Lisa Kausch, Holger Kunze, Maxim Privalov, André Klein, Jan El Barbari, Celia Martin Vicario, Jochen Franke, and Klaus Maier-Hein. "Computer-assisted contralateral side comparison of the ankle joint using flat panel technology." International Journal of Computer Assisted Radiology and Surgery 16, no. 5 (April 20, 2021): 767–77. http://dx.doi.org/10.1007/s11548-021-02329-w.
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Abstract Purpose Reduction and osteosynthesis of ankle fractures is a challenging surgical procedure when it comes to the verification of the reduction result. Evaluation is conducted using intra-operative imaging of the injured ankle and depends on the expertise of the surgeon. Studies suggest that intra-individual variance of the ankle bone shape and pose is considerably lower than the inter-individual variance. It stands to reason that the information gain from the healthy contralateral side can help to improve the evaluation. Method In this paper, an assistance system is proposed that provides a side-to-side view of the two ankle joints for visual comparison and instant evaluation using only one 3D C-arm image. Two convolutional neural networks (CNN) are employed to extract the relevant image regions and pose information of each ankle so that they can be aligned with each other. A first U-Net uses a sliding window to predict the location of each ankle. The standard plane estimation is formulated as segmentation problem so that a second U-Net predicts the three viewing planes for alignment. Results Experiments were conducted to assess the accuracy of the individual steps on 218 unilateral ankle datasets as well as the overall performance on 7 bilateral ankle datasets. The experiments on unilateral ankles yield a median position-to-plane error of $$0.73\pm 1.36$$ 0.73 ± 1.36 mm and a median angular error between 2.98$$^\circ $$ ∘ and 3.71$$^\circ $$ ∘ for the plane normals. Conclusion Standard plane estimation via segmentation outperforms direct pose regression. Furthermore, the complete pipeline was evaluated including ankle detection and subsequent plane estimation on bilateral datasets. The proposed pipeline enables a direct contralateral side comparison without additional radiation. This has the potential to ease and improve the intra-operative evaluation for the surgeons in the future and reduce the need for revision surgery.
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Grimes, C., and L. Horgan. "A New Algorithm for the Management of Critical Events in the Theatre." Bulletin of the Royal College of Surgeons of England 94, no. 2 (February 1, 2012): 1–2. http://dx.doi.org/10.1308/147363512x13189526438756.
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Patients may be subject to risk during surgery as a result of nontechnical as well as technical error. Effective surgical teams have been shown to have fewer problems per operation, higher intra-operative performance and shorter operating times. There is increasing evidence that interventions that improve teamwork, leadership, decision making, communication and situational awareness within operating teams also improve technical performance and patient outcome. In addition, briefings and debriefings before and at the end of operating lists have been shown to improve teamwork and communication, thereby improving patient safety.
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Belei, P., E. Schkommodau, A. Frenkel, T. Mumme, and K. Radermacher. "Computer-assisted single- or double-cut oblique osteotomies for the correction of lower limb deformities." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 221, no. 7 (July 1, 2007): 787–800. http://dx.doi.org/10.1243/09544119jeim276.
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Corrective osteotomy interventions on lower extremities are widely accepted procedures for restoring axial alignment of lower limbs. However, some studies reveal failure rates of up to 70 per cent in a 10 year time frame, which indicates that the success of corrective osteotomies depends on multiple factors. Based on a comprehensive review of error sources among conventional correction osteotomy interventions, a novel approach was developed in order to reduce these error sources among all clinical working steps (deformity determination, planning, and intra-operative realization). The article describes the implemented methodology for realizing optimal correction osteotomies based on a six-dimensional or 12-dimensional optimization module for single- and double-cut oblique osteotomies. The results show that the realized planning and navigation concept enables reduction in the error sources among the clinical working steps of correction osteotomy interventions.
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Cerrito, Patricia B., Steven C. Koenig, Daniel J. Van Himbergen, Saad F. Jaber, Dan L. Ewert, and Paul A. Spence. "Neural network pattern recognition analysis of graft flow characteristics improves intra-operative anastomotic error detection in minimally invasive CABG." European Journal of Cardio-Thoracic Surgery 16, no. 1 (July 1999): 88–93. http://dx.doi.org/10.1016/s1010-7940(99)00139-6.
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Ogata, Mitsuru, Leonor de Castro Monteiro Loffredo, Milton Carlos Kuga, and Gulnara Scaf. "Efficacy of three conditions of radiographic interpretation for assessment root canal length." Journal of Applied Oral Science 13, no. 1 (March 2005): 83–86. http://dx.doi.org/10.1590/s1678-77572005000100017.
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OBJECTIVE: To compare the efficacy of three conditions of image interpretation for radiographic root measurements and calculating the intra-observer reproducibility of the measurements. MATERIAL AND METHODS: Thirty intra-operative periapical radiographs of maxillary central and lateral incisors were measured, in mm, from the tip of the file to the radiographic apex, using a caliper. Three separate measurements were made of the 30 radiographs. The three measurements for each tooth were averaged and the mean used for further calculations. After a 12-day period, the measurements were repeated. The three experimental viewing conditions used: 1) standard viewbox without masking of background light around the radiograph and without magnification (Visual); 2) standard viewbox with use of a magnifying lens of 2.5x and with background light masked (Magnification); and 3) viewer device that restricts room lighting and enlarges the image by a magnifying lens of 1.75x (Viewer). The mean and standard deviation of the measurements were calculated and used for descriptive analysis. Two-way analysis of variance (ANOVA) was used to evaluate intra-observer and inter-method agreement of the measurements. The measurement error was estimated by Dalhberg's formula. RESULTS: The ANOVA showed no significant differences between measurement sessions, viewing methods, or interaction between observation session and method (p>0.05). The intra-observer measurement error was 0.02 mm for Visual and the Magnification methods and 0.01 mm for the Viewer. CONCLUSION: There does not seem to be any advantage in using viewbox masking or magnification for measuring the distance between the end of the endodontic file and the root apex in maxillary incisors.
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Maurya, Vinay P., Vandana Rana, Kanchan Kulhari, Prashant Kumar, Puneet Takkar, and Nitu Singh. "Analysis of intraoperative frozen section consultations and audit of accuracy: a two year experience in a tertiary care multispeciality hospital in India." International Journal of Research in Medical Sciences 8, no. 8 (July 24, 2020): 2782. http://dx.doi.org/10.18203/2320-6012.ijrms20203042.
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Background: Diagnostic accuracy of intra-operative frozen section (FS) depends largely on quality of tissue sections backed by good clinical communication and experience of reporting pathologist. Periodic audit of this consultation in surgical pathology help in assessing the efficiency of procedure and addressing the pitfalls. In this study authors have analysed the spectrum, indications and assessed the accuracy of FS consultation in their institution.Methods: A retrospective study of 212 consequent tissue specimens submitted for FS over two years in study centre was conducted. The FS and corresponding formalin fixed paraffin embedded (FFPE) tissue section with their final histopathological examination (HPE) reports were studied and analyzed. The results were classified in concordant, discordant and deferred categories. Accuracy rates and discordant frequencies were calculated and comparison with other similar studies was done. Reasons for inaccuracies were deduced.Results: A total of 212 tissue specimens for FS were reported over two years in this study institute, six of which showed discordant results. Most common site of FS in this study centre was from central nervous system (CNS) lesions (28.77%). Indications for intra-operative consultation were mainly for establishment of tumor diagnosis (66.51%) and status of margins (29.25%). The accuracy rate was found to be 97.17% with error rate of 2.83%. On analysis of discordant cases; the reason for inaccuracy was mainly due to interpretation error (83.33%).Conclusions: The audit of FS consultation established that accuracy rates of this study institution are comparable with most international quality control statistics for FS. The discordant cases were mostly false positive hence emphasising that a variable degree of reservation is required while interpreting and communicating the FS results. The closest possible diagnosis should be communicated on FS and definitive diagnosis should be deferred to HPE in case of doubt.
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Ferrari, Vincenzo, Andrea Moglia, and Mauro Ferrari. "Analytic description of the image to patient torso registration problem in image guided interventions." Journal of Biomedical Engineering and Informatics 1, no. 1 (August 5, 2015): 35. http://dx.doi.org/10.5430/jbei.v1n1p35.
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Objective: The accurate registration of virtual pre-operative information of the human body anatomy, obtained as images with imaging devices, with real intra-operative information is one of the key aspects on which effective Image Guided Surgery (IGS) is based. The registration of pre-operative images on the real patient, during abdominal and thoracic interventions, is influenced by many parameters, which in many cases are influenced each other, thus making it often difficult to define the problem and consequently to solve it for each specific kind of intervention. The objective of this paper is to obtain an analytic description of the 3D image to patient registration problem, which can be more intuitive than the traditional textual descriptions. Methods: The problem is formalized and various parameters affecting the registration are macro-classified in function of their nature. Results: The problem is analytically described discussing for each macro-category of parameters potential solutions to avoid or to reduce their contribution to the registration error. Conclusions: The availability of an analytic description of the image to patient torso registration problem can be beneficial for teaching IGS, to describe existing registration strategies, and to search new ones for each kind of surgery using a systematic approach.
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Guha, D., R. Jakubovic, and VX Yang. "GP.01 Quantification of computational geometric congruence in surface-based registration for spinal intra-operative three-dimensional navigation." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, S2 (June 2017): S7. http://dx.doi.org/10.1017/cjn.2017.60.
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Background: Computer-assisted navigation (CAN) may guide spinal instrumentation, and requires alignment of patient anatomy to imaging. Iterative-Closest-Point algorithms register anatomical and imaging datasets, which may fail in the presence of significant geometric congruence leading to inaccurate navigation. We computationally quantify geometric congruence in posterior spinal exposures, and identify predictors of potential navigation inaccuracy. Methods: Midline posterior exposures were performed from C1-S1 in four human cadavers. An optically-based CAN generated surface maps of the posterior elements at each level. Maps were reconstructed to include bilateral hemilamina, or unilateral hemilamina with/without the base of the spinous process. Maps were fitted to symmetrical geometries (cylindrical/spherical/planar) using computational modelling, and the degree of model fit quantified. Results: Increased cylindrical/spherical/planar symmetry was seen in the subaxial cervical spine relative to the high-cervical and thoracolumbar spine (p<0.001). Inclusion of the base of the spinous process decreased symmetry independent of spinal level (p<0.001). Registration with bilateral vs. unilateral hemilamina did not significantly reduce geometric symmetry. Conclusions: Geometric congruence is most evident at C1 and the subaxial cervical spine, warranting greater vigilance in navigation accuracy verification. At all levels, inclusion of the base of the spinous process in unilateral registration decreases the likelihood of geometric symmetry and navigation error.
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Cunningham, Bryan W., and Daina M. Brooks. "Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review." Global Spine Journal 12, no. 2_suppl (April 2022): 59S—74S. http://dx.doi.org/10.1177/21925682211035083.
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Study Design: Systematic review. Objectives: The optoelectronic camera source and data interpolation process serve as the foundation for navigational integrity in robotic-assisted surgical platforms. The current systematic review serves to provide a basis for the numerical disparity observed when comparing the intrinsic accuracy of optoelectronic cameras versus accuracy in the laboratory setting and clinical operative environments. Methods: Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. Results: A total of 465 references were vetted and 137 comprise the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy equaled or was less than 0.1 mm translation and 0.1 degrees rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm translation and 0.1 to 1.0 degrees rotation per array. Accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm translation and 1.5 to 5.0 degrees rotation when comparing planned to final implant position. Conclusions: Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position.
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Basques, Bryce A., Bryan M. Saltzman, Shane S. Korber, Ioanna K. Bolia, Erik N. Mayer, Bernard R. Bach, Nikhil N. Verma, Brian J. Cole, and Alexander E. Weber. "Resident Involvement in Arthroscopic Knee Surgery Is Not Associated With Increased Short-term Risk to Patients." Orthopaedic Journal of Sports Medicine 8, no. 12 (December 1, 2020): 232596712096746. http://dx.doi.org/10.1177/2325967120967460.
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Background: Whether resident involvement in surgical procedures affects intra- and/or postoperative outcomes is controversial. Purpose/Hypothesis: The purpose of this study was to compare operative time, adverse events, and readmission rate for arthroscopic knee surgery cases with and without resident involvement. We hypothesized that resident involvement would not negatively affect these variables. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of the prospectively maintained National Surgical Quality Improvement Program was performed. Patients who underwent arthroscopic knee surgery between 2005 and 2012 were identified. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Because of multiple statistical comparisons, a Bonferroni correction was used, and statistical significance was set at P < .004. Results: A total of 29,539 patients who underwent arthroscopic knee surgery were included in the study, and 11.3% of these patients had a resident involved with the case. The overall rate of adverse events was 1.62%. On multivariate analysis, resident involvement was not associated with increased rates of adverse events or readmission. Resident cases had a mean 6-minute increase in operative time ( P < .001). Conclusion: Overall, resident involvement in arthroscopic knee surgery was not associated with an increased risk of adverse events or readmission. Resident involvement was associated with only a mean increased operative time of 6 minutes, a difference that is not likely to be clinically significant. These results support the safety of resident involvement with arthroscopic knee surgery.