Dissertations / Theses on the topic 'Surgery'
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SANNAPPA, VENKATRAMAN SOUNDAPPAN SOUNDAPPAN. "Surgeon performed ultrasound in Paediatric Surgery." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/24950.
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Ultrasound is a ubiquitous imaging technique which has undergone rapid acceleration in technology since the1970s and its use has expanded to many specialties of medicine. It is however operator dependent and hence remained predominantly in the realms of sonographers and radiologists. The development of portable ultrasound equipment has enabled clinicians to increasingly use ultrasound as an extension of their clinical arm. Ultrasound has been used in outpatient evaluation, intensive care units, emergency and in the operating theatres for diagnostic and therapeutic purposes. While this practice is widespread in adult practice it is not as prevalent in paediatrics and specifically paediatric surgery. With the clinician’s first-hand knowledge of the patient’s history and physical examination the interpretation of the images should be more accurate, hence aiding diagnosis. Its application is particularly attractive in children because of absence of exposure to radiation and lack of need for an anaesthetic. The aim of this thesis is to extend the use of ultrasound into Paediatric Surgical clinical practice in a scholarly manner. Diagnostic and therapeutic role of use of surge
Chapter 2 is a literature review tracing history of diagnostic ultrasound and POCUS in
paediatrics.
Chapters 3-5 aimed to determine if Surgeon performed diagnostic ultrasound:
• Is as accurate as that performed by radiologists in diagnosis of common
acute paediatric surgical conditions.
• It will improve overall care in terms of time and cost-saving.
Chapter 6 studies the therapeutic role of ultrasound in percutaneous insertion of
central venous lines.
The study aimed to demonstrate if Ultrasound guided insertion was safe, time-saving
and avoid long-term complications.
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Chapter 7 is a review on skills required and discussion on accreditation in POCUS.
on performed ultrasound was studied.
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VOLPATTO, SILVIO. "Robotic technology and endoluminal surgery in digestive surgery." Doctoral thesis, Politecnico di Torino, 2018. http://hdl.handle.net/11583/2709912.
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BACKGROUND. Colorectal cancer (CRC) is the third most common cancer in males and second in females, and the fourth most common cause of cancer death worldwide. The implementation of screening programs has allowed to the identification of an increasing number of early-stage neoplastic lesions. Presently, superficial colorectal neoplasms (including precancerous lesions and early cancer) can be resected in the colon by Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), while in the rectum by Transanal Endoscopic Microsurgery (TEM). They are the preferred choices inside of the minimally invasive panorama regarding the CRC treatment. TEM technique offers more advantages than EMR and ESD, but it can’t overcome the recto-sigmoid junction. Many authors, research institutes and biomedical industries have proposed different solutions for microsurgery dissection of early lesions in the colon, but all these proposals have in common the development of platforms expressly designed for this use, with significant purchasing and management costs. The aim of our research project is to develop a robotic platform that allows to treat lesions throughout the colon limiting the costs of management and purchasing. This new robotic platform, developed in collaboration with Scuola Superiore Sant’Anna in Pisa, is called RED (Robot for Endoscopic Dissection). At the tip of a standard endoscope a hood (RED) is placed. RED is equipped by two extractable teleoperated robotic arms (i.e., diathermic hook and gripper); their motion is provided by onboard miniaturized commercial motors and a dedicated external platform. The endoscopist holds the endoscope near the lesion, while the operator drives the robotic arms through a remote control.
MATERIALS AND METHODS. Several preliminary studies have been conducted in the following order. A first test was conducted for identification of force value for lifting and pulling maneuvers using a modified TEM instrument. A CAD study was conducted to determine the maximum size that the hood must have in order to overcome the critical angle represented by the splenic flexure. Several tests were conducted to determine the degrees of freedom of each robotic arm, starting with the CAD drawing to make subsequently the mock-ups of each configuration. Finally, a 3D mock-up was produced that was assembled on an endoscope to perform the in vitro test to evaluate the workspace and field of view using a pelvic trainer for TEM.
RESULTS. The first test shown that the minimum force that the gripper will have to develop with the push-pull is 1.5N. The CAD study shown that the maximum dimensions the hood must have to overcome splenic flexure are: maximum diameter 28mm, maximum length 57mm. After several configurations was been tested, the final prototype features are: gripper arm with pitch sliding and open/close of the tip and diathermic hook arm with pitch, roll and sliding. There will be 6 such distributed motors: 3 external motors for the gripper arm that will operate through cables contained in a sheath adherent to colonscope and 3 embedded motors for diathermic hook arm (one integrated on the hood for the sliding degree of motion and the other two inside of the arm). The in-vitro test has been carried out to evaluate the workspace and they proved that the operating field vision is not obstructed by the hood and the working range is sufficiently wide to perform a dissection.
CONCLUSION. Tests conducted up to this point have allowed us to identify the overall layout of the RED: dimensions, degrees of freedom, number and distribution of motors needed for the operation of robotic arms; moreover, it is proved that the device, once assembled, maintained the visual and operational field characteristics necessary to perform an accurate dissection. The next step will be to realize a RED steel final prototype and in-vivo tests will be carry out to replicate an endoscopic dissection into the colon.
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Zolotaryova, A. "Plastic surgery." Thesis, Сумський державний університет, 2013. http://essuir.sumdu.edu.ua/handle/123456789/33929.
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Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand surgery, microsurgery, and the treatment of burns.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/33929
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Morkvin, Y., R. Kremeznoy, Наталія Ігорівна Муліна, Наталия Игоревна Мулина, and Nataliia Ihorivna Mulina. "Robotic surgery." Thesis, Сумський державний університет, 2013. http://essuir.sumdu.edu.ua/handle/123456789/31098.
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Surgery is a field of study that deals mainly with lives especially that of the human life. A lot of activities take place in the theatre, as surgeons and other medical personnel are usually faced with problem of saving human live via surgical operations. Sometimes, errors occur in course of operating on delicate parts of the body, which might result to severe injury and sometimes death due to inaccuracy on the side of surgeons. This is the reason why it is imperative that the issue of error should be corrected using a well developed machine called ROBOT to perform delicate surgical operations as they can only do that which they have been programmed for.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/31098
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Shen, Jun. "Framework for ultrasonography-based augmented reality in robotic surgery : application to transoral surgery and gastrointestinal surgery." Thesis, Rennes 1, 2019. http://www.theses.fr/2019REN1S078.
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Cette thèse porte sur le développement d’une solution de réalité augmentée dans le cadre de la chirurgie robotisée et plus particulièrement pour la chirurgie transorale des tumeurs de la base de langue et la chirurgie laparoscopique des cancers du bas rectum. Une des problématiques pour les chirurgiens est de repérer sur la vue endoscopique les limites de la tumeur et les marges de résections. Celles-ci sont en effet non visibles directement. L’échographie peropératoire est largement utilisée pour repérer les tumeurs lors des interventions. Nous proposons donc une solution de réalité augmentée dans laquelle l’information extraite de l’échographie est reprojetée sur la vision binoculaire de la station de chirurgie robotisée afin de guider le chirurgien dans la résection de la tumeur. Plusieurs verrous de cette chaîne de traitement ont été repérés et étudiés. Nous avons ainsi proposé une nouvelle méthode pour la calibration de sondes d’échographie. Nous avons démontré que cette méthode était plus facile à mettre en œuvre, plus rapide et plus précise que les méthodes proposées dans la littérature. Cette sonde calibrée, associée à des outils de localisation et de calibration de la sonde endoscopique nous a permis de proposer une solution de réalité augmentée qui permettait de reprojeter l’information acquise sur l’image sur la vue endoscopique avec des erreurs inférieures à 1 mm. Nous avons alors établi la preuve de concept de l’application de cette chaîne de réalité augmentée dans deux expérimentations, l’une sur un fantôme physique en silicone du rectum et l’autre sur une langue de mouton en ex-vivo. Les résultats expérimentaux ont montré que l’information augmentée avait permis au chirurgien de percevoir avec précision les marges de résections des tumeurs simulées et d’accomplir le geste opératoire à l’aide de cette perceptionThe medical context of this thesis is transoral robotic surgery for base of tongue cancer and robot-assisted laparoscopic surgery for low-rectal cancer. One of the main challenges for surgeons to perform these two surgical procedures is to identify the tumor resection margins accurately, because tumors are often concealed in base of tongues or rectal walls and there is lack of efficient intraoperative guidance systems. However, ultrasonography is widely used to image soft-tissue tumors, which motivates our proposition of an augmented reality framework based on intraoperative ultrasonography images for tumor resection guidance. The framework, proposed, with clinical partners, consists to adapt to the surgical workflow of robot-assisted surgery for treating base of tongue cancer and low-rectal cancer. For this purpose, we developed a fast and accurate 3D ultrasound probe calibration method to track the probe and facilitate its intraoperative use. Moreover, we evaluated the performance of the proposed framework augmenting an intraoperative endoscopic camera with ultrasound information, which shows less than 1mm error. Furthermore, we designed experimental protocols using a silicone rectum phantom and an ex-vivo lamb tongue, that simulate the integration of the implemented framework into the current surgical workflow. The experimental results show that, according to the augmented endoscopic views provided by the proposed framework, a surgeon is able to accurately identify the resection margins of the simulated tumors in these phantoms
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Hauck, Robert. "Virtual surgery and orthopaedic surgery : towards training using haptic technology." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/38530/.
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Medical education and practical training in surgery is changing, by shifting from an on the job learning paradigm, which possesses problems such as that it is unpredictable, dependent on clinical needs and that patient safety may be jeopardised, to an evidence-based surgical skills training driven by curricular needs, and acquiring basic surgical skills prior to assisting in the operating theatre and thus reducing operation duration. Towards achieving this goal, virtual reality (VR) simulators are used in minimally invasive surgery for technical skills training at the beginning of the learning curve, but have not yet been adapted for open surgery due to its complexity for simulation. This thesis investigated the potential of using a VR simulator for training in orthopaedic hand surgery, with an emphasis on providing a meaningful, effective and motivating addition to current training methods for surgical procedures. A review of literature, preliminary research projects and currently available surgical systems revealed limited results on whether a VR simulation of orthopaedic hand surgery could be created, fulfilling the needs of medical experts. Therefore, a study investigating the current state of medical education and to understand the expectations on such a simulator was carried out, which resulted in the identification of promising medical scenarios for simulation (such as carpal tunnel release, distal radius fracture treatment or surgical incision) and in requirements for its development. Different software frameworks have been evaluated for their ability for use by analysing five developed demonstrators, with the result that a custom implementation of a six-degrees-of-freedom haptic algorithm was required. By following a human-centred design approach, a VR surgical simulator with inbuilt objective measures of assessment has been developed, allowing applying a plate, drilling holes, measuring their lengths, inserting screws and taking virtual X-rays, supported by haptic feedback for increased realism and teaching aspects not possible by common computer-based simulators, such as feeling the resistance when drilling through the cortical bone. By close collaboration with medical experts and following user interface design principles, a carried out medical evaluation of the simulator showed that the simulator was well-received by the targeted young doctors and medical students, that relevant aspects of the implemented medical scenario are taught and that the users’ performance can be assessed. The findings of this work showed that it is possible to create an interactive VR simulator aimed at early stages to learn basic orthopaedic principles of open surgery using the example of the treatment of distal radius fractures in a meaningful manner. It addresses issues in the current medical education and enables learning educational objectives repeatedly in reusable medical scenarios and in a safe and controlled environment, without the risk of harming patients, and thus contributing to improved quality and patient safety when proceeding to the operating theatre.
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Tran, Hanh Minh. "Advances in Minimally Invasive Hernia Surgery: Single Incision Laparoscopic Surgery." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13646.
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Minimally invasive surgery has become increasingly adopted in the treatment of abdominal wall hernias. Indeed, in 2014, 51% of all inguinal hernias were repaired laparoscopically in Australia. In an attempt to further reduce parietal trauma single-incision laparoscopic surgery (SILS) has potential to reduce trocar-induced injuries, port-site hernias, post-op pain, analgesic requirement, quicken return to work/physical activities and improve cosmetic results. The relative loss of triangulation to perform the repair can be overcome using small and longer laparoscope, modifying dissection techniques and with increasing experience. Our prospective randomized controlled study comparing single-port vs multiport totally extraperitoneal inguinal herniorraphy confirmed safety, efficacy, cosmetic and non-cosmetic benefits of single-port approach and, with further technical refinement, by dissecting the extraperitoneal space under direct vision and hence obviating the need for costly balloon dissectors, we demonstrated it was possible to retain the benefits of single-port surgery while making it highly cost effective compared to multiport surgery. Having overcome technical challenges of single-port technique, we demonstrated that SILS can safely be applied to other types of abdominal wall pathologies including diastasis of the recti, ventral/incisional, spigelian, parastomal and re-recurrent inguinal hernias. This thesis demonstrates that SILS presents a credible alternative to conventional multiport hernia surgery.
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Nguyen, Nga Quynh. "Surgery on frames." [College Station, Tex. : Texas A&M University, 2008. http://hdl.handle.net/1969.1/ETD-TAMU-2994.
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Resch, Sylvia. "Hallux valgus surgery." Lund, Sweden : Dept. of Orthopedics, University Hospital, 1995. http://catalog.hathitrust.org/api/volumes/oclc/37990161.html.
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Rhodes, Andrew. "Outcomes from surgery." Thesis, St George's, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604015.
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This thesis explores the utility of critical care following surgery. In particular, it assesses whether there are differences in how countries provide for critical ca re following surgery and whether these impact on outcomes. A meta-analysis of pre-emptive haemodynamic interventions in surgery was shown to reduce complications and mortality. Many of these interventions required the use of critical care which limited their utility. An analysis of a quality Austrian critical ca re database enabled an understanding of the group of patients admitted to critical care following surgery and the factors that are important in determining outcome. By utilizing these factors in a hierarchical logistic regression model, I demonstrated that outcomes are improving. Unfortunately, the provision of healthcare is not the same throughout Europe. Extrapolating data from Austria to the United Kingdom is therefore difficult. A further study was completed to identify differences in critical care provision between European countries. This study was hampered by inconsistent definitions of what an intensive care bed is, although did find a worryingly wide difference in beds per head of population. This must have implications for the case mix of patients admitted (or refused) to critical ca re and therefore surgical outcomes. A final study was performed to assess whether there were differences in outcomes at a national level. In this large observational study, critical care utilization varied following surgery and mortality rates were higher than expected with significant differences found between individual countries. In conclusion, critical care is a vital part of the surgical pathway for a select group of patients. Unless this group can be understood and quantified, then healthcare providers will be unable to develop systems that are able to cope with the likely demand. Only by matching this demand will optimal ca re be delivered.
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Streletskyi, Ye S., and S. S. Strizhak. "Robotics serving surgery." Thesis, Sumy State University, 2017. http://essuir.sumdu.edu.ua/handle/123456789/62810.
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Tan, Jackie. "Sutureless Corneal Surgery." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/28463.
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Aim
There is an urgent clinical need to seal leaking corneal wounds to improve ophthalmic outcomes. We investigated if OcuRep®, a thin-film, chitosan-based, laser activated corneal adhesive is safe and capable of sealing penetrating corneal incisions suturelessly.
Methods
This thesis reports the findings from a systematic review of corneal sealants. Ex and in vivo studies in bovine and rabbit models then assessed the efficacy of OcuRep® in sealing corneal wounds by comparing the highest tolerable intraocular pressure against sutures or ‘self-sealing’ wounds. Lastly, laser retinal safety was assessed using ex and in vivo bovine and rabbit models.
Results
Seven studies with level 2 or higher evidence were included in the systematic review, these were ReSure®, OcuSeal®, fibrin glue, and cyanoacrylate. Favored characteristics were: ‘on-demand’ activation, cured quickly, sealed hermetically, and improved healing.
OcuRep® sealed penetrating corneal incisions in the ex vivo bovine and rabbit models and tolerated significantly higher burst pressures than sutured or self-sealed incisions of up to 6 mm long. In the in vivo rabbit model, OcuRep® treated incisions healed significantly faster than sutured or self-sealed incisions and exceeded the highest measurable limit of our experimental setup of 360 mmHg from 72 hours to 2 weeks. Rabbits treated with OcuRep® had significantly higher modified McDonald-Shadduck scores for the first 72 hours compared to sutured or self-sealed, but no significant difference to self-sealed incisions at 1 and 2 weeks. The activation of OcuRep® was operator-controlled and was quick and easy to apply.
The laser used to activate OcuRep® did not cause any ophthalmoscopic or histologic changes in our rabbit model. However, when the laser fluence was increased beyond required for OcuRep® activation, coagulative necrosis of the retinal pigmented epithelium and neural retina was observed.
Conclusion
OcuRep® had characteristics required of an ocular sealant, it was capable of sealing penetrating corneal incisions and tolerated higher burst pressures than sutures. The laser for activating OcuRep® did not cause retinal damage. This technology has competitive advantages compared to existing sealants and the translation of this technology into sutureless corneal surgeries in humans is possible.
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Avcil, Tuba [Verfasser], and Arkadiusz [Akademischer Betreuer] Miernik. "Single‑incision transumbilical surgery (SITUS) versus single‑port laparoscopic surgery (SPLS) versus conventional laparoscopic surgery (CLS) im Trainingslabor." Freiburg : Universität, 2019. http://d-nb.info/1206537043/34.
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Schmitt, Robin L. "BARIATRIC SURGERY: WHAT IS THE RELATIONSHIP BETWEEN BARIATRIC SURGERY PATIENTS AND THEIR SELF-EFFICACY TOWARD THE RECOMMENDATIONS OF BARIATRIC SURGERY?" Columbus, Ohio : Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1243907012.
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Watson, David Ian. "Improving outcomes following surgery for gastro-oesophageal reflux disease : laparoscopic antireflux surgery /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phw338.pdf.
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Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1998.Copies of the just first page of author's previously published articles inserted. Includes bibliographical references (leaves 227-254).
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Miyake, Makoto. "Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/264637.
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D'Urso, Paul Steven. "Stereolithographic biomodelling in surgery /." [St. Lucia, Qld.], 1998. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17881.pdf.
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Decadt, Bart. "Evidence-based laparoscopic surgery." Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268504.
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Zhang, Xingru. "Topics on Dehn surgery." Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/32117.
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Cyclic surgery on satellite knots in S³ is classified and a necessary condition is given for a knot in S³ to admit a nontrivial cyclic surgery with slope m/l, \m\ > 1. A complete classification
of cyclic group actions on the Poincaré sphere with 1-dimensional fixed point sets is obtained. It is proved that the following knots have property I, i.e. the fundamental group of the manifold obtained by Dehn surgery on such a knot cannot be the binary icosahedral group I₁₂₀, the fundamental group of the Poincaré homology 3-sphere: nontrefoil torus knots, satellite knots, nontrefoil generalized double knots, periodic knots with some possible specific exceptions, amphicheiral strongly invertible knots, certain families of pretzel knots. Further the Poincaré sphere cannot be obtained by Dehn surgery on slice knots and a certain family of knots formed by band-connect sums. It is proved that if a nonsufficiently large hyperbolic knot in S³ admits two nontrivial cyclic Dehn surgeries then there is at least one nonintegral boundary slope for the knot. There are examples of such knots. Thus nonintegral boundary slopes exist.Science, Faculty of
Mathematics, Department of
Graduate
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de, Lorenzi Francesca. "Refinements in microvascular surgery." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2003. http://arno.unimaas.nl/show.cgi?fid=6025.
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Bringman, Sven. "Minimally invasive hernia surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-466-6/.
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Schuurman, Peter Richard. "Thalamic surgery for tremor." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2002. http://dare.uva.nl/document/65876.
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Tarazi, Kamal. "Computer assisted orthopaedic surgery." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321608.
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Rowsell, Anthony Richard. "Intra-uterine foetal surgery." Thesis, University of Oxford, 1988. http://ora.ox.ac.uk/objects/uuid:5a97d2ca-ea8a-441a-890a-1a529b6897c3.
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Mohamed, Bragheeth Mohamed Abd El-Naby. "Lamellar corneal refractive surgery." Thesis, University of Nottingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403907.
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Laidlaw, David Alistair Hunter. "Second eye cataract surgery." Thesis, University of Bristol, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322548.
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Ashby, Elizabeth. "Morbidity following orthopaedic surgery." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10054431/.
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Morbidity following hip and knee arthroplasty has previously been poorly recorded. This is the first time the Post-Operative Morbidity Survey (POMS) has been used for this purpose. The POMS identifies clinically significant morbidity using indicators of organ system dysfunction rather than traditional diagnostic categories. The most common types of morbidity following hip and knee arthroplasty are infection and renal morbidity. Pulmonary, pain and gastro-intestinal morbidity are less common. Cardiovascular, wound, neurological and haematological morbidity are least common. Many arthroplasty patients remain in hospital without morbidity. The POMS identifies these patients and thus has potential as a prospective bed utilisation tool. To be used for this purpose, the POMS must identify all clinically significant morbidity. Mobility is an important factor for safe discharge of arthroplasty patients. Addition of a ‘mobility’ domain could improve the utility of POMS as a bed utilisation tool following orthopaedic surgery. This study showed no association between post-operative morbidity defined by the POMS and longer-term patient-reported outcome measures (PROMs). This study does not support the POMS as an early surrogate marker of long-term PROMs in orthopaedic patients. The wound domain of the POMS has a high specificity, reasonable sensitivity, high negative predictive value and low positive predictive value compared to the inpatient ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, inpatient Stay over 14 days) score. The wound domain of POMS could be replaced with a validated definition of wound infection such as ASEPSIS. On the same series of orthopaedic patients, surgical site infection (SSI) rate according to the Centres for Disease Control (CDC) definition was 15.45%, according to the Nosocomial Infection National Surveillance Scheme (NINSS) definition was 11.32% and according to the ASEPSIS definition was 8.79%. This highlights the need for a consistent definition of SSI.
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Uppal, G. S. "Surgery for macular disease." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1333992/.
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The MD will primarily examine the role of surgery in the management of the wet form of age related macular degeneration (AMD) and secondarily for specific inherited macular dystrophies. It is postulated that in the early stages of wet AMD and other sub-foveal disorders involving choroidal neovascular membranes (CNV), photoreceptor loss is relatively limited with the disease confined to the sub-foveal layers, namely the choriocapilliaris-Bruch membrane-retinal pigment epithelium (RPE) interface. At this stage the retina is affected functionally and reversibly but with time the damage becomes permanent and irreversible. As such a critical window of opportunity exists to: 1. Salvage function from the existing photoreceptor pool before fibrovascular proliferation causes marked ‘irreversible’ photoreceptor loss 2. Treat any visual loss that may be due to secondary and potentially ‘reversible’ factors such as sub-foveal fluid and haemorrhage and 3. Mechanically restore normal anatomy. Previous attempts at sub-macular surgery have been associated with the loss of RPE in the area of the CNV during removal that secondarily causes degeneration of photoreceptors. Consequently, different innovative surgical approaches, including 360-degree macular translocation and full thickness autologous RPE transplantation, are under investigation for the management of sub-foveal CNV. The rationale of surgery in both techniques is to effectively restore the choriocapilliaris-Bruch’s-RPE interface beneath the foveal photoreceptors and rescue function before fibrovascular proliferation causes marked ‘irreversible’ photoreceptor loss. Pilot studies have been established to: 1. Examine the surgical feasibility and the anatomical and functional outcomes for each procedure 2. Investigate the pathophysiology of the underlying disease processes. In addition, a number of parameters will be investigated to evaluate the quality of recovery of vision. This will include assessing fixation stability, reading ability, histopathological studies and electrophysiological correlates.
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Almoudaris, Alex. "High performance in surgery." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/25511.
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The national identification of high performing providers in surgery is of prime importance to patients, surgeons and commissioners of healthcare. This thesis explores how high performance is identified, defined and measured nationally and attempts to identify the factors that underlie high performance in colorectal cancer surgery during the peri-operative period. An introduction into the determinants of high performance in surgery as well as defining quality as it pertains to surgery is then undertaken. Identification of available national data sources and metrics for national performance are then identified. Comparison is made between voluntary and compulsory reporting systems highlighting greater capture of peri-operative mortality in compulsory reporting datasets. A novel marker that reflects outcome following complication management is developed. This marker is based on re-operations and is derived from compulsory reporting datasets. The use of non-operative re-interventions is then assessed in oesophago-gastric cancer resections as proof of concept. An appraisal of all colorectal cancer units in England is then undertaken using a panel of metrics demonstrating that analysis on a single marker alone may be too simplistic. Identifying factors that pertain to high performance beyond those available from routinely available datasets using a novel methodological approach called HiPer (High Performance) is performed. The interview based methodology identified rich qualitative factors in a group of colorectal cancer units worldwide that may be causal in their performance status. Finally, results from the interview study were related to hard outcome data from each unit which demonstrated some correlation between the HiPer methodology and the outcome data in the final section of the feasibility study. The implications of this may be that a dual approach of analysing routinely collected data with a more qualitative HiPer style methodology may help us better understand how high performing units achieve their results.
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Hendry, Paul. "Enhanced recovery after surgery." Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/29151.
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The Enhanced Recovery After Surgery model of perioperative care targets the obstacles to recovery following major abdominal surgery: pain, gastrointestinal dysfunction and immobility. This model of care combines elements that have individually been shown to attenuate the surgical stress response, reduce postoperative analgesia requirement or maintain perioperative nutrition. Through combining these elements it has been possible to improve early postoperative function and reduce the requirement for hospital stay with an unaltered or even reduced complication rate. Within the available ERAS studies subjective postoperative outcomes are employed and it is difficult to assess the true contribution of many of the individual protocol elements to postoperative recovery. The reduction in length of stay, in itself, may represent more efficient use of inpatient care rather than an improved rate of functional recovery. Further refinement and validation of the ERAS model will be achieved by establishing randomised controlled trials that test its feasibility and effectiveness within other surgical specialties, establish objective, reproducible outcome measures and examine the specific contribution of individual protocol elements within the ERAS protocol. It is expected that further improvement in postoperative recovery may specifically rely on reducing gut dysfunction in the early postoperative period. The establishment of randomised controlled trials and objective endpoints will facilitate testing individual element that target gastrointestinal recovery. This thesis demonstrates that the application of an ERAS model of care to hepatic surgery is feasible and results in a reduction in postoperative stay similar to that seen in colorectal surgery. This suggests that the ERAS programme of care may be extrapolated to other surgical specialties. The present thesis also demonstrates that activity meters and stable isotope gastric empting breath tests can be employed in the early postoperative period to provide objective measures of postoperative recovery. Most significantly this thesis demonstrates through a randomised controlled trial that within an ERAS protocol early routine administration of laxatives can improve postoperative rate of gastrointestinal recovery following hepatic resection.
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Мадяр, Володимир Васильович, Владимир Васильевич Мадяр, Volodymyr Vasylovych Madiar, and A. Magyfwa. "Surgery in pulmonary tuberculosis." Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/15964.
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Aksenchuk, R. I. "Developent of the surgery." Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/25980.
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Ali, Omair. "Outcomes of refractive surgery." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12262.
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Thesis (M.A.)--Boston UniversityProcedures to reshape the cornea to correct refractive errors have been a longstanding and fast-evolving area of interest for centuries. As recent advances in excimer laser technology allow keratorefractive treatments to deliver precise treatments with fewer associated risks and complications, the popularity of modern refractive procedures continues to grow at unprecedented rates. For this reason, it is imperative to continue correlating patient characteristics to outcomes so that refractive surgeons can more accurately foresee the results of the selected procedure. This study examined the outcomes of refractive surgeries at a full-scope ophthalmology clinic from January 2011 to November 2011. The main objectives of th is study were to determine the differences between the outcomes of LASIK vs. LASEK, Custom vs. Traditional treatment plans, myopic vs. hyperopic patients and MMC exposure vs. no MMC exposure (LASEK only). More importantly, the data was scrutinized to determine whether or not any of these treatments and/or patient characteristics correlated with poor visual outcomes or the need for an enhancement. Of the 590 myopic eyes treated with Custom LASIK, 90.85% (n=536 eyes) had UDVA of 20/20 or better, 96.10% (n=567 eyes) had UDVA of 20/25 or better and 99.32% (n=586 eyes) had UDVA of 20/40 or better. Of the 170 myopic eyes treated with Custom LASEK, 70.59% (n=120 eyes) had a UDVA of 20/20 or better, 82.94% (n=141 eyes) had a UDVA of 20/25 or better and 96.47% (n=164 eyes) had a UDVA of 20/40 or better. Of the 45 hyperopic eyes that were treated with Traditional LASIK, 44.44% (n=20 eyes) had postoperative UDVA of 20/20 or better, 62.22% (n=28 eyes) had postoperative UDVA of 20/25 or better and 82.22% (n=37 eyes) had postoperative UDVA of 20/40 or better. Of the 536 eyes receiving LASIK, 91.42% (n=490 eyes) had an UDVA of 20/20 or better, 96.46% (n=517 eyes) had an UDVA of 20/25 or better and 99.44% (n=533 eyes) had an UDVA of 20/40 or better. Of the 146 low or moderately myopic eyes receiving Custom LASEK, 74.65% (n=106 eyes) had an UDVA of 20/20 or better, 86.62% (n=123 eyes) had an UDVA of 20/25 or better and 96.48% (n=137 eyes) had an UDVA of 20/40 or better. Of the 54 highly myopic eyes treated with Custom LASIK, 85.19% (n=46 eyes) had an UDVA of 20/20 or better, 92.59% (n=50 eyes) had an UDVA of 20/25 or better, and 98.15% (n=53 eyes) had an UDVA of 20/40 or better. Of the 28 highly myopic eyes treated with Custom LASEK, 53.57% (n=15 eyes) had an UDVA of 20/20 or better, 64.29% (n=18 eyes) had an UDVA of 20/25 or better, and 96.43% (n=27 eyes) had an UDVA of 20/40 or better. An analysis of these data yields significantly greater percentages of myopic (low, moderate and high) eyes achieving 20/20 or better after treatment by Custom LASIK versus Custom LASEK. The data suggested no correlations between poor visual outcomes and/or the need for an enhancement treatment and intraoperative complications, magnitude of ametropia, pupil size, age, treatment type, and treatment plan. All of the LASEK patients who underwent an enhancement treatment were exposed to MMC during their original procedure. Hyperopic patients displayed significantly reduced visual outcomes than comparable myopic treatments. Future studies should investigate similar preoperative characteristics and attempt to correlate them to results to improve predictability and, thus, visual outcomes.
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Perttunen, Kristiina. "Pain after thoracic surgery." Helsinki : University of Helsinki, 2003. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/perttunen/.
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Moonesinghe, S. R. "Risk in major surgery." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1418539/.
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A qualitative systematic review was conducted to assess the performance of tools which have been validated for the prediction of morbidity and/or mortality, in heterogeneous cohorts of surgical (non-cardiac, non-neurological) patients. The Portsmouth- Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and the Surgical Risk Scale (SRS) were found to be the most widely validated and accurate risk stratification tools. The POSSUM, P-POSSUM and SRS were then validated in a population of patients who had major non-cardiac surgery in a metropolitan UK hospital. Their accuracy (discrimination) was compared against two novel predictors - the additive POSSUM score and the POSSUM physiology score. P-POSSUM and the additive POSSUM score predicted short-term mortality with high-moderate accuracy. The POSSUM Physiology score was moderately accurate and therefore worthy of further evaluation. Both POSSUM and P-POSSUM were poorly calibrated for this population. The relationships between perioperative risk, postoperative morbidity (measured using the Post Operative Morbidity Survey, POMS), postoperative length of hospital stay, and short-term mortality, were explored in a series of univariate analyses. There were differences in short-term mortality, and the patterns and prevalence of POMS-defined morbidity between surgical specialities. Cox Proportional Hazards Modelling, using time-dependent covariates, was undertaken to explore the independent relationship between perioperative risk, postoperative morbidity and long-term survival. POMS-defined neurological morbidity (prevalence 2.9%) was independently associated with reduced long-term survival. Prolonged postoperative morbidity, defined as the presence of POMS-defined morbidity on Day 15 post-surgery (prevalence 15.6%), conferred a relative hazard for death in the first 12 months post surgery of 3.52 (p<0.001; 95% C.I. 2.23-5.43) and for the next two years of 2.33 (p<0.001; 95% C.I. 1.56-3.50). Postoperative morbidity is a significant public health issue and poses a risk to longer-term survival; it would be an important measure of the quality of perioperative healthcare.
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Salleh, Rosli. "Minimally invasive surgery training and tele-surgery system using VR and haptic techniques." Thesis, University of Salford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365996.
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Muallem, Jumana [Verfasser]. "Upper abdominal surgery in advanced epithelial ovarian cancer diaphragm surgery in focus / Jumana Muallem." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2019. http://d-nb.info/1202042821/34.
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Harfmann-Ludwig, Susanne. "Bowel habits after bariatric surgery /." [S.l.] : [s.n.], 2009. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Dinkelbach, Jonathan. "Equivariant Ricci-Flow with Surgery." Diss., lmu, 2008. http://nbn-resolving.de/urn:nbn:de:bvb:19-91361.
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Ribenis, Aksels. "Epilepsy surgery around language cortex." Diss., lmu, 2009. http://nbn-resolving.de/urn:nbn:de:bvb:19-98318.
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Nazaikinskii, Vladimir, and Boris Sternin. "On surgery in elliptic theory." Universität Potsdam, 2000. http://opus.kobv.de/ubp/volltexte/2008/2587/.
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We prove a general theorem on the behavior of the relative index under surgery for a wide class of Fredholm operators, including relative index theorems for elliptic operators due to Gromov-Lawson, Anghel, Teleman, Booß-Bavnbek-Wojciechowski, et al. as special cases. In conjunction with additional conditions (like symmetry conditions), this theorem permits one to compute the analytical index of a given operator. In particular, we obtain new index formulas for elliptic pseudodifferential operators and quantized canonical transformations on manifolds with conical singularities.
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Byrne, Benjamin. "High performance in colorectal surgery." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/34688.
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A large body of international outcomes research has documented significant variation in the results of health care, beyond differences attributable to patient age, comorbidity or chance. Naturally, quality of care, however measured, may vary by provider within a health care system. Yet detailed understanding of the relationship between quality of care and health care outcomes continues to elude researchers. Much research has focused on the patient level, determining which patient-focused clinical processes deliver the best outcomes. By contrast, there is a relative lack of research examining intermediate and higher levels, to understand team performance and how teams work to provide high quality care, though research in this area is growing. This thesis aims to develop a greater understanding of how the best colorectal surgical units may be identified, and how they achieve their results. Chapter 1 provides background to the present approach to the assessment of performance in health care. Chapter 2 summarises salient surgical outcomes research, and chapter 3 presents a literature review of evidence associating specific organisational structures and processes with clinical outcomes. Chapter 4 presents a patient questionnaire study, undertaken to assess the involvement of patients with gastrointestinal cancer in choosing a provider, and what provider-level information patients consider important. Chapters 5 to 8 describe the methods and results of a series of studies using routine administrative data to explore changes within colorectal surgery over time, as well as the relationship between different outcome measures at the unit level. Chapters 9 to 12 present research designed to understand how units achieve their results. This work included developing a semi-structured interview to better understand the key organisational factors determining length of stay after elective colonic surgery. Chapter 13 summarises the main findings and limitations of this thesis, and discusses its implications for practice and future research.
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Tekkis, Paris Procopiou. "Risk-adjustment in gastrointestinal surgery." Thesis, University of London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406906.
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Zhou, Jilin. "Collaborative tele-haptic surgery simulation." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/27104.
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The main thesis objective is to develop a Collaborative Tele-Haptic Surgery Simulation based on a generic system architecture for Collaborative Haptic Audio-visual Virtual Environments (C-HAVE) with integrated haptics and Collaborative Virtual Environment (CVE) object modeling. A haptic device is a kind of human computer interface that can generate tactile and force feedback to the users. Thus, the users can get the feel of 'touch' while manipulating the virtual objects. Three prototypes based on different architectures are quantitatively compared to demonstrate the effects of adding haptics to a task. In the generic system architecture, a Haptic Real-Time Controller (HRTC) is used to compensate the effects of network latency on the haptic coupling.
A collaborative tele-haptic surgery simulation for tracheotomy is designed and implemented, based on the generic architecture. In our simulation, users from different physical locations are coupled together through haptic devices over some networks and operate collaboratively to perform the surgery. In addition, the simulation provides the functionality that a trainer can coach a trainee on how to perform the surgery successfully in a tele-mentoring manner.
This thesis also contains in-depth overviews of virtual reality and haptic interfaces. The stability issue of haptic interaction with a virtual environment is discussed. Some software implemention issues of the virtual reality system are also included.
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Beyene, Ayne, and Tewelle Welemariam. "Concept Drift in Surgery Prediction." Thesis, Blekinge Tekniska Högskola, Sektionen för datavetenskap och kommunikation, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-2330.
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Context: In healthcare, the decision of patient referral evolves through time because of changes in scientific developments, and clinical practices. Existing decision support systems of patient referral are based on the expert systems approach. This usually requires manual updates when changes in clinical practices occur. Automatically updating the decision support system by identifying and handling so-called concept drift improves the efficiency of healthcare systems. In the stateof-the- art, there are only specific ways of handling concept drift; developing a more generic technique which works regardless of restrictions on how slow, fast, sudden, gradual, local, global, cyclical, noisy or otherwise changes in internal distribution, is still a challenge. Objectives: An algorithm that handles concept drift in surgery prediction is investigated. Concept drift detection techniques are evaluated to find out a suitable detection technique in the context of surgery prediction. Moreover, a plausible combination of detection and handling algorithms including the proposed algorithm, Trigger Based Ensemble (TBE)+, are evaluated on hospital data. Method: Experiments are conducted to investigates the impact of concept drift on prediction performance and to reduce concept drift impact. The experiments compare three existing methods (AWE, Active Classifier, Learn++) and the proposed algorithm, Trigger Based Ensemble(TBE). Real-world dataset from orthopedics department of Belkinge hospital and other domain dataset are used in the experiment. Results: The negative impact of concept drift in surgery prediction is investigated. The relationship between temporal changes in data distribution and surgery prediction concept drift is identified. Furthermore, the proposed algorithm is evaluated and compared with existing handling approaches. Conclusion: The proposed algorithm, Trigger Based Ensemble (TBE), is capable of detecting the occurrences of concept drifts and to adapt quickly to various changes. The Trigger Based Ensemble algorithm performed comparatively better or sometimes similar to the existing concept drift handling algorithms in the absence of noise. Moreover, the performance of Trigger Based Ensemble is consistent for small and large dataset. The research is of twofold contributions, in that it is improving surgery prediction performance as well as contributing one competitive concept drift handling algorithm to the area of computer science.
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Casarin, Stefano. "Mathematical models in computational surgery." Thesis, La Rochelle, 2017. http://www.theses.fr/2017LAROS008/document.
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La chirurgie informatisée est une science nouvelle dont le but est de croiser la chirurgie avec les sciences de l’informatique afin d’aboutir à des améliorations significatives dans les deux domaines. Avec l’évolution des nouvelles techniques chirurgicales, une collaboration étroite entre chirurgiens et chercheurs est devenue à la fois inévitable et essentielle à l’optimisation des soins chirurgicaux. L’utilisation de modèles mathématiques est la pierre angulaire de ce nouveau domaine. Cette thèse démontre comment une approche systématique d’un problème clinique nous a amenés à répondre à des questions ouvertes dans le domaine chirurgical en utilisant des modèles mathématiques à grande échelle. De manière générale, notre approche inclut (i) une vision générale du problème, (ii) le ciblage du/des système(s) physiologique(s) à étudier pour y répondre, et (iii) un effort de modélisation mathématique, qui a toujours été poussé par la recherche d’un compromis entre complexité du système étudié et réalité physiologique. Nous avons consacré la première partie de cette thèse à l’optimisation des conditions limites à appliquer à un bio-réacteur utilisé pour démultiplier le tissu pulmonaire provenant d’un donneur. Un modèle géométrique de l’arbre trachéo-bronchique couplé à un modèle de dépôt de soluté nous a permis de déterminer l’ensemble des pressions à appliquer aux pompes servant le bio-réacteur afin d’obtenir une distribution optimale des nutriments à travers les cultures de tissus. Nous avons consacré la seconde partie de cette thèse au problème de resténose des greffes de veines utilisées pour contourner une occlusion artérielle. Nous avons reproduit l’apparition de resténose grâce à plusieurs modèles mathématiques qui permettent d’étudier les preuves cliniques et de tester des hypothèses cliniques avec un niveau croissant de complexité et de précision. Pour finir, nous avons développé un cadre de travail robuste pour tester les effets des thérapies géniques afin de limiter la resténose. Une découverte intéressante a été de constater qu’en contrôlant un groupe de gènes spécifique, la perméabilité à la lumière double après un mois de suivi. Grace aux résultats obtenus, nous avons démontré que la modélisation mathématique peut servir de puissant outil pour l’innovation chirurgicaleComputational surgery is a new science that aims to intersect surgery and computational sciences in order to bring significant improvements in both fields. With the evolution of new surgical techniques, a close collaboration between surgeons and computational scientists became unavoidable and also essential to optimize surgical care. A large usage of mathematical models is the cornerstone in this new field. The present thesis shows how a systematic approach to a clinical problem brought us to answer open questions in the field of surgery by using mathematical models on a large scale. In general, our approach includes (i) an overview of the problem, (ii) the individuation of which physiological system/s is/are to be studied to address the question, and (iii) a mathematical modeling effort, which has been always driven by the pursue of a compromise between system complexity and closeness to the physiological reality. In the first part, we focused on the optimization of the boundary conditions to be applied to a bioreactor used to re-populate lung tissue from donor. A geometrical model of tracheobronchial tree combined with a solute deposition model allowed us to retrieve the set of pressures to be applied to the pumps serving the bioreactor in order to reach an optimal distribution of nourishment across the lung scaffold. In the second part, we focused on the issue of post-surgical restenosis of vein grafts used to bypass arterial occlusions. We replicated the event of restenosis with several mathematical models that allow us to study the clinical evidences and to test hypothesis with an escalating level of complexity and accuracy. Finally, we developed a solid framework to test the effect of gene therapies aimed to limit the restenosis. Interestingly, we found that by controlling a specific group of genes, the lumen patency is double after a month of follow-up. With the results achieved, we proved how mathematical modeling can be used as a powerful tool for surgical innovation
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Warnock, Fay F. "Children's recovery from day surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq21271.pdf.
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Lundin, Anders. "Corticosteroids in Lumbar Disc Surgery." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6126.
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Jersenius, Ulf. "New techniques in liver surgery /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-596-8/.
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Widman, Jan. "Blood saving in orthopaedic surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-220-5.
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