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Koudstaal, Maarten Jan. "Surgically asisted rapid maxillary expansion; surgical and orthodontic aspects." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2008. http://hdl.handle.net/1765/12608.
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Bann, Simon David. "Objective assessment of surgical skills in basic surgical trainees." Thesis, Imperial College London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405129.
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Yu, Justin M. Eng (Justin K. )Massachusetts Institute of Technology. "Predicting post-surgical opioid consumption using perioperative surgical data." Thesis, Massachusetts Institute of Technology, 2020. https://hdl.handle.net/1721.1/130199.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, May, 2020<br>"May 2020." Date of graduation confirmed by MIT Registrar Office. Cataloged from student-submitted PDF of thesis.<br>Includes bibliographical references (pages 49-50).<br>Improper consumption of prescription opioids is a massive public health issue in the United States currently. Here, we propose one approach of tackling this issue through using machine learning techniques to predict opioid consumption post discharge for surgical patients. Through the data collected from surgical patients at BIDMC, relevant features will be identified and used to predict if patients high, outlier consumption. Using logistic regression and gradient boosted decision trees, model performance were evaluated at AUCs of 0.7270 and 0.7289 respectively.<br>by Justin Yu.<br>M. Eng.<br>M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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Haddad, Sleiman. "Surgical site infections in spinal surgery: from risk factors to surgical outcomes." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665823.
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Durante la última década ha aumentado significativamente el volumen de cirugías de columna, además de la complejidad tanto médica como quirúrgica de los pacientes tratados. Esto ha dado lugar a un aumento de complicaciones asociadas. Los profesionales de la salud son ahora más conscientes del impacto de ciertas complicaciones prevenibles, especialmente la infección de la herida quirúrgica (IHQ), cosa que ha provocado un aumento de los esfuerzos para reducir su incidencia. Se han descrito factores de riesgo generales para las IHQ. No obstante, el rol del estado neurológico y del traumatismo no se han analizado específicamente. Además, el impacto de las IHQ en los resultados clínicos tras la cirugía de deformidad espinal del adulto (DEA) aún no está claro.
El objetivo de esta tesis doctoral es revisar los factores de riesgo de la IHQ en la cirugía del raquis así como su impacto sobre el resultado final. Se centra principalmente en el diagnóstico (traumático vs. degenerativo) y el estado neurológico (Lesión medular LM o mielopatía MP) como predictores de la IHQ. También informa de las morbilidades y los costes asociados y evalúa los resultados quirúrgicos después de una IHQ.
La National Inpatient Survey (NIS) y la base de datos del Thomas Jefferson University Hospital (TJUH) se usaron para analizar la infección en la cirugía cervical primaria. Mediante un análisis multivariante, se analizaron los posibles factores de riesgo incluyendo el trauma y la lesión neurológica. Luego se procedió a un análisis de costes. La base de datos del European Spine Study Group (ESSG) sirvió para evaluar su impacto sobre los resultados funcionales y clínicos en pacientes con fusión posterior para la DEA mediante la comparación de cohortes emparejadas.
Un total de 1.247.281 (NIS) y 5.540 (TJUH) pacientes cumplieron los criterios de inclusión. La incidencia de la IHQ fue de 0.73% (NIS) y 1.75% (TJUH). Aumentó progresivamente desde 0,52% en pacientes sin MP hasta 1,97% en el grupo con LM traumática en la muestra del NIS y desde 0,88% a 5,54% en TJUH. Hubo diferencias significativas en las tasas de IHQ entre muestras. El estado neurológico (Odds Ratio [OR] 1,69, p<.0001) y el trauma (OR 1.30, p=.0003) fueron asociados a IHQ en la muestra del NIS. En la muestra del TJUH, solo el trauma (OR 2.11, p=.03) era significativo cuando se tuvieron en cuenta las otras comorbilidades. Los costes de la infección variaron entre los grupos diagnósticos y alcanzaron $184060 en el grupo LM traumática. Los pacientes con IHQ utilizaron con más frecuencia las instituciones especializadas al alta.
Se identificaron 444 pacientes con DEA tratados quirúrgicamente y con más de 2 años de seguimiento. 20 padecieron una IHQ aguda y fueron emparejados a 60 controles. No se observaron diferencias basales entre grupos tanto en variables radiológicas como calidad de vida. Los pacientes con IHQ tuvieron una estancia hospitalaria más prolongada y más complicaciones mecánicas. La infección se asoció a más complicaciones y revisiones no relacionadas. La corrección de la deformidad se mantuvo indiferentemente de la infección a lo largo del seguimiento. Hubo una muerte relacionada con IHQ. Los pacientes con IHQ presentaban peor calidad de vida al año y tenían menos probabilidades de experimentar mejoría. Sin embargo, no se registraron diferencias significativas a partir del año.
Como conclusión, tanto el diagnóstico primario (trauma vs. degenerativo) como el estado neurológico (MP o LM) son predictores de la IHQ en cirugía cervical. La infección afecta significativamente el primer año después de la cirugía de la DEA, se asocia con más complicaciones, revisiones no relacionadas y peor calidad de vida. Sin embargo, su impacto negativo parece diluirse en el segundo año.<br>Over the last decade there has been a significant increase in volume of spinal surgeries performed as well as in medical and surgical complexity of patients. This was accompanied by an increased overall morbidity and volume of complications. At the same time, health care professionals have become more aware of the impact of specific preventable complications such as surgical site infections (SSI) and huge efforts have been directed to reduce SSI incidence. Although the general risk factors for SSI have been discussed, the relationship of neurologic status and trauma to SSI has not been explicitly explored. In addition, the direct and indirect impact of deep SSI on surgical outcomes especially after adult spinal deformity (ASD) surgery is still unclear.
The aim of this doctoral thesis is to review the risk factors for developing a SSI after spine surgery, as well as how SSI affects clinical outcome. It mainly focuses on diagnosis (Traumatic vs. Degenerative) and neurological status (Spinal Cord Injury SCI or Myelopathy MP) as predictors for SSI. It also reports the associated morbidities and costs of SSI and evaluates the surgical outcomes after SSI. The National Inpatient Survey (NIS) and the Thomas Jefferson University Hospital (TJUH) databases were probed to analyse infection in patients with primary cervical surgery. Using a multivariate analysis, all interplaying comorbidities and risk factors have been. A subsequent resource utilization analysis has been done. The European Spine Study Group (ESSG) prospective database was used to study the functional and clinical outcomes of SSI in patients with posterior fusion for Adult Spinal Deformity (ASD) through the comparison of matched cohorts. Readmissions, reoperations, deformity correction and fusion rates were also studied.
A total of 1,247,281 and 5,540 patients met inclusion criteria in the NIS and TJUH databases respectively. SSI incidence was 0.73% (NIS) versus 1.75% (TJUH). It increased steadily from 0.52% in patients without MP to 1.97% in the traumatic SCI group in the NIS data and from 0.88% to 5.54% in the TJUH. Differences between diagnostic groups and cohorts reached statistical significance. SSI was predicted significantly by neurological status (odds ratio [OR] 1.69, p<.0001) and trauma (OR 1.30, p=.0003) in the NIS data. Other significant predictors included: approach, number of levels fused, female gender, black race, medium size hospital, rural hospital, large hospital, western US hospital and Medicare coverage. In TJUH, only trauma (OR 2.11, p=.03) reached significance when accounting for comorbidities. Costs of infection varied among diagnostic groups and summed $184060 in the SCI group. Patients with SSI were also more likely to be discharged to specialized institutions.
444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter.
As a conclusion, both primary diagnosis (trauma vs. degenerative) and neurologic status (MP or SCI) were found to be strong and independent predictors of SSI in cervical spine surgery. Also, SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it's negative impact seems to be diluted by the second postoperative year.
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Ho, Kam-yuen Simon. "Healing responses following surgical/non-surgical treatment in residual periodontally-involved sites." View the Table of Contents & Abstract, 2004. http://sunzi.lib.hku.hk/hkuto/record/B36787681.
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Ho, Kam-yuen Simon, and 何錦源. "Healing responses following surgical/non-surgical treatment in residual periodontally-involved sites." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B43895463.
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Iseki, Hiroshi, Yoshihiro Muragaki, Ryoichi Nakamura, Mikhail Chernov, and Kintomo Takakura. "Surgical information strategy Desk." INTELLIGENT MEDIA INTEGRATION NAGOYA UNIVERSITY / COE, 2006. http://hdl.handle.net/2237/10415.
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Stott, Philip Martin. "Surgical knots and sutures." Thesis, University of Sussex, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436228.
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MacKenzie, Colin. "Assessment of surgical performance." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/55250.
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Surgical patient outcomes are related to technical and non-technical skills of the surgeon. Trauma patient operative and management experience has declined since trainee duty-hour restrictions were mandated in 2003 resulting in less experience in technical surgical skills. The Advanced Surgical Skills for Exposure in Trauma (ASSET) cadaver-based course, teaching vascular exposure and haemorrhage control, was developed to fill this training gap. The aim of this Thesis is to develop surgeon performance metrics and to test surgeons before and after taking the ASSET course to determine whether such training improves performance of peripheral vascular control. The importance of training in surgical vascular control in both civilian and military practice, and a description of current surgical training for trauma are described in Chapter 1. Reviews of existing trauma training courses and surgical performance metrics are provided in Chapters 2 and 3, and show limited testing of training courses and lack of trauma surgical performance metrics. Data collection methods, evaluator training and analysis are described in Chapter 4. Chapter 5 evaluates self-confidence of surgeons performing the vascular control procedures in cadavers compared to the performance evaluated by trained evaluators. Preliminary validation of vascular-control performance metrics and testing of a standardized script with item analysis and inter-rater reliability are discussed in Chapter 6. Testing 40 surgeons performing 3 extremity vascular control procedures before and after training is reported in Chapter 7. ASSET training improves performance, but large performance variability, repeated errors and no improvements were found in some surgeons. Chapter 8 reports how blind video analysis checklist, global rating metrics, error occurrence and recovery show convergent validity with co-located evaluators. Chapter 9 identifies the key findings and implications, innovation of the work described in the Thesis and concludes with the potential impact on military readiness and my personal reflection on what I learnt.
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Giataganas, Petros. "Robotics for surgical microscopy." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/46198.
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Advances in surgery have had a significant impact on cancer treatment and management. Recurrence, however, is still a major issue, and is often associated with incomplete tumour removal. Thus far, histopathological examination is still the “gold standard” for assessing tumour resection completeness. However, it is operator-dependent and too slow for intraoperative use. Recently developed endomicroscopy techniques enable the acquisition of high resolution images at a cellular level in situ, in vivo, thus significantly extending the information content available intraoperatively. The miniaturised imaging probes incorporate flexible fibre bundles and allow the ease of integration with surgical instruments. However, manual control of these probes is challenging, particularly in terms of maintaining consistent tissue contact and performing large area surveillance of complex, deformable, 3D structures. This thesis explores the use of surgical robots and robotically-assisted probe manipulation to provide stable, precise, consistent and dexterous manipulation of endomicroscopy probes for surgical applications. Following a discussion of image enhancement techniques, a first approach towards robotically-assisted probe manipulation using existing surgical robotic platforms is demonstrated in the form of multi-purpose, pick-up probes. They also incorporate novel force adaptive mechanisms for consistent tissue contact. The development of bespoke, mechatronically-enhanced robotic devices is then presented. Firstly, a handheld robotic scanning device is proposed for breast conserving surgery, allowing accurate, high speed scanning over wide deformable tissue areas. An energy delivery fibre is integrated into the scanning mechanism for image-guided ablation or intraoperative marking of tumour margins. Secondly, a dexterous 5-degree-of-freedom robotic instrument is proposed for use in endoluminal microsurgeries. The instrument offers increased flexibility and by using a master-slave control scheme, we demonstrate how efficient, large area scanning over curved endoluminal surfaces can be performed. Finally, the fusion of ultrasound imaging with endomicroscopy is investigated through the development of a robotically-actuated articulated instrument for multi-modality image fusion.
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Beersing-Vasquez, Kiran. "Suturing in Surgical Simulations." Thesis, KTH, Numerisk analys, NA, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-260254.
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The goal of this project is to develop virtual surgical simulation software in order to simulate the suturing and knot tying processes associated with surgical thread. State equations are formulated using Lagrangian mechanics, which is useful for the conservation of energy. Solver methods are developed with theory based in Differential Algebraic Equations (DAEs) which concern governing Ordinary Differential Equations (ODEs) that are constraint with Algebraic Equations (AE). An implicit integration scheme and Newton's method is used to solve the system in each step. Furthermore, a collision response process based on the Linear Complementarity Problem (LCP) is implemented to handle collisions and measure their forces. Models have been developed to represent the different types of objects. A spline model is used to represent the suture and mass-spring model for the tissue. They were both selected for their efficiency and base on real physical properties. The spline model was also chosen as it is continuous and can be evaluated at any point along the length. Other objects are also defined such as rigid bodies. The Lagrangian multiplier method is used to define the constraints in the model. This allows for the construction of complex models. An important constraint is the suturing constraint, which is created when a sufficient force is applied by the suture tip on to the tissue. This constraint allows only a sliding point along the suture to pass through a specific point on the tissue. This results in a virtual suturing model which can be built on for use in surgical simulations. Further investigations would be interesting to increase performance, accuracy and scope of the simulator.<br>Det här projektet syftar till att utveckla mjukvara för virtuell simulering av kirurgi som involverar knytande av suturtråd. Lagranges ekvationer används för att härleda energibevarande tillståndsekvationer. Lösningsmetoderna grundar sig i teori från området Differential-Algebraiska Ekvationer (DAEer), som avser att kontrollera Ordinära Differentialekvationer (ODEer) med algebraiska bivillkor. Ett implicit integrationsschema och Newtons metod används för att lösa systemet i varje steg. Utöver det så implementeras en kollisionsrespons-process baserad på det linjära komplementaritetsproblemet (LCP) för att hantera kollisioner och mäta deras krafter. Modeller har utvecklats för att representera olika typer av objekt. En spline-modell används för att representera suturtråden och ett mass-fjäder system för vävnaden. Valet baserades på deras höga prestanda samt starka anknytning till objektens fysiska egenskaper. Spline-modellen valdes också då dess kontinuitet innebär att den går att evaluera för en godtycklig punkt inom dess domän. Andra objekt, såsom stela kroppar, finns också definierade. Lagrangemultiplikator används för att definiera bivillkor i modellen. Detta tillåter konstruktionen av komplexa modeller. Ett viktigt bivillkor är sutur-bivillkoret som uppstår när tillräcklig kraft från spetsen på den kirurgiska nålen appliceras på vävnaden. Detta bivillkor tillåter att endast en glidande punkt längsmed suturen passerar genom en specifik punkt på vävnaden. Detta resulterar i en virtuell modell för stygn som kan byggas vidare på för användning i kirurgiska simulationer. Det vore intressant med ytterligare undersökningar för att förbättra prestandan, precisionen och simulatorns omfattning.
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Ragde, Siri Fenstad. "Characterization of surgical staff `s exposure to surgical smoke at St. Olavs Hospital." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for samfunnsmedisin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-19642.
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Introduction: Surgical smoke is produced when electrosurgery is applied to the patient`s tissue during surgical procedures. The smoke is known to contain numerous of volatile chemical compounds, and carcinogens have been identified. The smoke also contains ultrafine particles, which may propose a health hazard to the surgical staff in the operating room. Methods: The aim of the study was to characterize the personal exposure of surgical smoke to the surgical personnel in the operating room, with emphasis on ultrafine particles. Five surgical procedures were selected to be included in the exposure assessment based on frequent use of electrosurgery and relatively short length of the procedures. Sampling of personal exposure to particles in surgical smoke in the range of 5.6-560 nm was performed using a Fast Mobility Particle Sizer, on four different job groups in the operating room. Important determinants of exposure were also investigated, using linear mixed effects models. In addition, three random samples of exposure to volatile organic compounds and aldehydes were executed on the main surgeon on three types of surgeries. Results: Type of surgery was an important determinant of exposure to surgical smoke, and the use of electrosurgery resulted in exposure to mainly ultrafine particles. The exposure was highest during abdominoplasty and the lowest during hip replacement surgeries. A total of five VOC`s was identified and quantified. One sample contained low levels of formaldehyde. For the other samples, the levels were below the detection limit. Conclusion: The use of electrosurgery resulted in short term high peak exposures to mainly ultrafine particles in surgical smoke. The job groups closest to the emissions are usually the highest exposed. Compared to other working environments the exposure levels for ultrafine particles was low. The concentrations of VOC`s and aldehydes was below the Norwegian OEL.
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Nygaard, Andreas. "High-Level Control System for Remote Controlled Surgical Robots : Haptic Guidance of Surgical Robot." Thesis, Norwegian University of Science and Technology, Department of Engineering Cybernetics, 2008. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-8864.
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<p>This report considers the work to improve the autonomy of surgical teleoperated systems, by introducing haptic guidance. The use of surgical robots in surgical procedures have become more common the recent years, but still it is in its infancy. Some advantages when using robots is scalability of movements, reduced tremor, better visualisation systems and greater range of motions than with conventional minimally invasive surgery. On the contrary, lack of tactile feedback and highly unstructured medical environment restricts the use of teleoperated robots to specific tasks within specific procedures. A way of improving autonomy of the teleoperated system is to introduce predefined constraints in the surgical environment, to create a trajectory or forbidden area, in order to guide the movements of the surgeon. This is often called haptic guidance. This report introduces the basics of teleoperated systems, with control schemes, models and analytical tools. Algorithms for haptic guidance have been developed, and the entire control and guidance system have been modified and suited for implementation on a real teleoperated system. Theoretical analysis of the position position (PP) control scheme reveals some general stability and performance characteristics, later used as a basis for tuning the real system parameters. The teleoperated system consists of a Phantom Omni device, from SensAble-Technologies, used as master manipulator, and AESOP 3000DS, from Computer Motions Inc., as the slave manipulator. The control system is implemented on a regular PC, connecting the complete system. Tests reveal that the slave manipulator is not suited for this task due to a significant communication time delay, limited velocity and inadequate control possibilities. The consequences makes force feedback based on the PP control scheme impossible, and limits performance of the entire teleoperated system. The guidance system is implemented in two variations, one based on slave positions and one based on master positions. This is motivated to give a performance comparison for variations of position error/tracking between the two manipulators. Slave based guidance appears to be stable only for limited values of the gains, and thus, it generates no strict constraints. It can be used to guide the operator away from forbidden areas, but is not suitable for high precision guiding. The master based guidance is stabile for very high gains, and the guidance have the accuracy to improve the surgeons precision during procedures. In the case of line guidance, the master based guidance gives a deviation of up to $1.3mm$ from the given trajectory. The work has shown the possibilities of using haptic guidance to improve accuracy and precision in surgical procedures, but among others, hardware limitations give room for several improvements in order to develop a teleoperated system that works.</p>
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BARDI, EDOARDO. "STANDARDIZATION OF MINIMALLY INVASIVE SURGICAL AND PERI-SURGICAL PROCEDURES IN POND SLIDERS (TRACHEMYS SCRIPTA)." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/816287.
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North American pond sliders (Trachemys scripta) are invasive alien species that, following the release of pet specimens in the wild over the decades, have established breeding populations outside their native habitat, with detrimental effects on local biodiversity. Their commerce and breeding have been recently banned in the European Union, and national programs are being introduced by Union Members to eradicate and control their presence. Aims of the present PhD project were to elaborate on this species’ minimally invasive ovariectomy regarding surgical, anesthesiologic and analgesic aspects, and to dwell on the concept of population control, possibly providing means alternative to surgical gonadectomy.
The first study included in the present thesis is a comparison between dorsal and lateral recumbency during endoscope assisted oophorectomy. Ovariectomy via the prefemoral fossa, with or without endoscopic assistance, is a well-described technique for elective and therapeutic sterilization in chelonians. The choice between lateral and dorsal recumbency is generally left to the surgeon’s preference, with no data supporting an objective superiority of one over the other. Twenty-four sexually mature female pond sliders were enrolled for this study, and were randomly divided in two groups: 12 animals were placed in right lateral recumbency with a left fossa approach (Group A), and 12 in dorsal recumbency with a right fossa approach (Group B). Scoring systems were applied to assess the ease of access to the coelomic cavity, and the ease of identification of the ovary opposite to the surgical incision; total surgery times and necessity to perform bilateral access were recorded. A negative correlation was found between the body weight of the animals and the ease of access to the coelom (p = 0.013), making the access easier in smaller animals. No significant difference was found between the two groups in terms of ease of access to the coelomic cavity, first ovary removal time, ease of identification of the second ovary, second ovary removal time, or total surgery time. It can be concluded that endoscope-assisted prefemoral ovariectomy in mature pond sliders can be indifferently performed in lateral or dorsal recumbency, depending on the preference of the surgeon, on the animal’s pathophysiologic status, or on the necessity to perform concurrent procedures.
The second study is the description and comparison of two totally intramuscular anesthetic protocols. Chelonian anesthesia is a challenge for reptile practitioners: the capability of these animals to hold their breath for a considerable amount of time, and the ability of the chelonian heart to perform right-to-left shunts, make inhalant maintenance less predictable and reliable. Intravenous administration of anesthetic drugs can pose problems as well, since the difficulty of obtaining and maintaining IV catheters in non-complying patients. Anesthetic induction and maintenance by the intramuscular (IM) route circumvent these problems, but the number of multimodal protocols available for this purpose is limited. Twenty-six sexually mature female pond sliders undergoing elective prefemoral ovariectomy were enrolled for this study, and were randomly divided in two groups: Group A received a IM combination of ketamine 3 mg/kg + dexmedetomidine 0.1 mg/kg + midazolam 0.5 mg/kg + alfaxalone 8.5 mg/kg; Group B was premedicated with morphine 1 mg/kg IM 1 hour prior to induction, which was achieved via ketamine 3 mg/kg + dexmedetomidine 0.1 mg/kg + midazolam 0.5 mg/kg + alfaxalone 5 mg/kg IM. Time of loss of and recurrence of spontaneous movement, muscle and cloacal tone, and limb withdrawal latency, time to intubation, heart rate (HR), need for isoflurane administration, recovery time and total anesthesia time were recorded and compared between the two groups. Results indicate that IM administration of dexmedetomidine/ketamine/midazolam/alfaxalone alone (Group A) or in combination with morphine (Group B) provided an adequate anesthetic depth for surgical purpose respectively in 76.9% and 100% of animals, witnessed by the lack of reaction to skin incision and organs manipulation and resection. No marked cardiovascular effects were recorded but, if compared to basal values, Group B displayed a significantly lower HR in the first 15 minutes of surgery, likely determined by the cardiorespiratory effects of morphine. Protocol B showed quicker loss of measured parameters, shorter mean induction time (11 ± 5 vs 22 ±5 minutes, p = 0.00001), quicker recurrence of measured parameters and shorter recovery time (21 ±12 vs 36 ±22 minutes, p = 0.04). Both protocols were safe and provided quick induction and recovery time; premedication with morphine allowed to lower the dosage of alfaxalone, and the resulting protocol provided surgical anesthesia suitable for the whole length of the procedure without requiring inhalant maintenance.
The third study evaluated the role of differentially expressed plasmatic micro RNAs (miRNAs) as possible biomarkers for surgical pain in pond sliders. Plasma of female turtles that underwent surgical gonadectomy were collected 24 hours pre-surgery, and 2.5 hours and 36 hours post-surgery; the expression of miRNAs was profiled by Next Generation Sequencing and the dysregulated miRNAs were validated using RT-qPCR. The diagnostic value of miRNAs was calculated by ROC curves, and the pointed out that, out of 14 differentially expressed miRNAs, miR-499-3p and miR-203-5p were effectively modulated. MiR-203-5p was fair (AUC: 0.7934) in discriminating pre-and 36h post-surgery samples and poor for other time points, while miR-499-3p was excellent (AUC: 0.944) in discriminating pre-surgery and 2.5h post-surgery samples, and fair in discriminating pre-surgery and 36h post-surgery (AUC:0.7292) and 2.5h and 36h post-surgery (AUC:0.7569) samples. In conclusion, it was demonstrated for the first time that miRNAs profile changes in plasma of turtles underwent surgical oophorectomy and identified miR-203-5p and miR-499-3p as potential candidate biomarkers.
The last study investigated the efficacy of single and double IM 4.7 deslorelin acetate implant in suppressing fertility in female pond sliders. The use of long-acting GnRH-agonists has been poorly investigated in reptiles, and the few available studies show inconsistent results. Twenty sexually mature turtles were divided into three groups: one single-implant groups (6 animals), one double-implant group (6 animals) and one control group (no implant). During one reproductive season (March to October), plasmatic concentration of sexual hormones (estradiol, progesterone and testosterone) and ovarian morphometric activity via computed tomography were monitored about every 30 days. A significative (p = 0.011) decrease in the number of phase-II ovarian follicles was detected in the double-implant group when compared with the control group, but no significant difference was noted regarding the number of phase-III and phase-IV follicles, egg production, and sexual hormones plasmatic concentration. Results show that neither a single or double deslorelin acetate implant can successfully inhibit reproduction in female pond sliders during the ongoing season, but the lower number of phase-II follicles in the double-implant group can possibly be associated to a reduced fertility in following seasons.
The present PhD project confirms the poor feasibility of non-surgical sterilization in chelonians and improves the knowledge on endoscopic-assisted ovariectomy, providing useful insight regarding not only the surgical procedure, but also regarding anesthesiologic concerns and pain management in these animals. Obtained results confirm this surgery as a highly specialistic procedures, and its massive application in the context of population control programs is questionable.
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Kragsterman, Björn. "Carotid Artery Stenosis : Surgical Aspects." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6834.
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<p>Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion. </p><p>The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac disease and contralateral occlusion. Median survival time was 10.8 years for the symptomatic and 10.2 years for the asymptomatic group. </p><p>Tolerance to carotid clamping during CEA under general anaesthesia was evaluated in 62 patients measuring cerebral oximetry, transit time volume flowmetry and stump pressure. High internal carotid artery flow before clamping and low stump pressure was associated with decreased oxygenation after clamping suggesting shunt indication. </p><p>In 18 patients undergoing CEA, jugular bulb blood samples demonstrated significantly altered levels of marker for inflammatory activation (IL-6) and fibrinolytic activity (D-dimer and PAI-1) during carotid clamping as compared to radial artery levels. This indicates a cerebral ischaemia due to clamping although clinically well tolerated. </p><p>In conclusion, the perioperative outcome after CEA in Sweden compared well with the RCTs results. Tolerance to carotid clamping may be evaluated by combining stump pressure and volume flow measurements. Although clinically tolerated clamping may induce a cerebral ischaemic response.</p>
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Kwakye, Gifty. "GREEN PRACTICES FOR SURGICAL UNITS." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03152010-165830/.
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The study aimed to identify leading practices to promote environmentally friendly and efficient efforts in surgical healthcare. Despite widespread enthusiasm for going green in the U.S. economy, little information is available to inform the medical community on the effort. We explore safe and efficient strategies for hospitals and healthcare providers to protect the environment while delivering high-quality care. As part of the study design, we performed a systematic review of the literature using relevant Pubmed search terms and surveyed a panel of hospital managers and CEOs of healthcare organizations pursuing green initiatives. Recommendations were itemized and reviewed with each panelist for a consensus agreement. At the end, we identified forty-three published articles and obtained interview data from the 7-member expert panel. Five green recommendations for surgical practices were identified: (1) OR Waste Reduction and Segregation; (2) Environmentally Preferable Purchasing; (3) Energy Consumption Management; (4) Pharmaceutical Waste Management; (5) Reprocessing of Single Use Medical Devices. We concluded that the medical community has a large opportunity to implement green practices in surgical units. These practices can have significant benefits to both the healthcare community and the environment.
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Wagner, Glenn Nick. "Investigation of fish surgical techniques." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ43233.pdf.
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Kragsterman, Björn. "Carotid artery stenosis : surgical aspects /." Uppsala : Acta Universitatis Upsaliensis : Univ.bibl. [distributör], 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6834.
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Nohr, Carl William. "Humoral immunity in surgical patients." Thesis, McGill University, 1988. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=75969.
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Humoral immune function was studied in surgical patients. The antibody response to vaccination with a protein antigen, tetanus toxoid (TT), was reduced among all patients, especially those with reduced delayed type hypersensitivity (DTH) and increased degree of physiological derangement. The antibody response to a polysaccharide antigen, pneumococcal polysaccharide (PPS), was normal. In trauma patients, the antibody response to TT was normal. The in vitro production of specific and total immunoglobulin (Ig) by blood mononuclear cells was studied. Patients that failed to produce a serum antibody response to TT also failed to produce anti-TT in vitro. Anti-PPS production was normal. More total Ig was produced by patients, especially those with reduced DTH responses. Some patients showed a reduction, rather than the normal increase, in Ig synthesis with mitogen stimulation. These data show evidence of humoral immune deficiency to protein antigens, and in vivo activation of the B cell system.
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Chow, Ling-yu Velda, and 周令宇. "Surgical management of pharyngoesophageal tumours." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2015. http://hdl.handle.net/10722/212561.
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Pharyngoesophageal (PE) tumours are tumours involving simultaneously the hypopharynx and the cervical oesophagus. The challenge in its surgical management lies in its deep-seated location behind the manubrium bone in the cervicothoracic region, in close proximity to great vessels in the lower neck and superior mediastinum.
Classically curative surgery is in the form of total pharyngo-laryngo-oesophagectomy (PLO) and gastric pull-up (GPU) via a three-phase one-stage operation. However PLO and GPU is a major undertaking associated with high operative morbidity and reported in-hospital mortality rates of up to 10%.
With a comprehensive preoperative work-up we demonstrated accurate tumour diagnosis and staging, with a 100% negative predictive rate. Together with vigilant postoperative surveillance and compliant follow-up, incidence of synchronous and metachronous tumours were low at 11.9% and 1.7% respectively.
Manubrial resection (MR) provided access to PE tumours in the cervicothoracic region enabling resection under direct vision with adequate resection margins - pharyngo-laryngo-cervico-oesophagectomy (PLCO). The trachea was resected and re-sited as a mediastinal tracheostoma in case of posterior tracheal wall invasion. Paratracheal and paraoesophageal lymph node dissection was performed in case of nodal metastasis. MR provided ample space for reconstruction of the resultant defect. Furthermore, it enabled access to vessels in the superior mediastinum to support microvascular tissue transfer. Intra-thoracic volume changes on maximal inspiration and expiration measured using computed tomography scan did not show significant difference pre- and post- MR. With attention to operative details, MR proved to be safe with minimal functional disturbance.
Free jejunal (FJ) flap was the preferred reconstructive modality as it offered the lowest pharyngocutaneous fistula and anastomotic stricture rates, and donor site morbidities. All patients resumed unrestricted oral diet postoperation. Videofluoroscopic swallowing studies (VFSS) and high resolution manometry (HRM) demonstrated significantly prolonged transit times for all bolus consistencies compared with normal subjects due to asynchronous contractions between the FJ and the oesophageal remnant, presence of retrograde propulsion and residue accumulation within the FJ. However, patients reported significant improvement in swallowing outcomes and associated quality of life (QOL) compared with preoperation (65.3% vs. 42.7%, p=0.02). Majority of patients were able to speak conveniently with a modality of their choice.
MR, PLCO and FJ flap showed significantly lower operative morbidities (58.3% vs. 85.7%, p=0.05), shorter hospital stay (42.5 vs. 50.7 days, p=0.37), and lower in-hospital mortality (8.3% vs. 9.5%, p=0.52) compared with PLO and GPU. None required intensive care unit postoperation. In resecting less, oncological outcomes and survival were not inferior to PLO and GPU. FJ patients were able to resume oral diet sooner than GPU with a higher functional oral intake scale (FOIS) at 6 months (100.0% vs. 92.8%). Shorter transit times for all bolus consistencies were demonstrated in VFSS and HRM of GPU patients due to the lack of contractions within the gastric tube. Swallowing, speech and associated QOL outcomes were comparable between the 2 groups.
In conclusion, MR, PLCO and FJ flap should be adopted in the surgical management of patients with isolated PE tumours.<br>published_or_final_version<br>Surgery<br>Master<br>Master of Surgery
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Munafo, Marcus Robert. "Psychological factors and surgical recovery." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310289.
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Iyer, R. "Surgical outcomes in gynaecological oncology." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1482204/.
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Presently there are no reliable statistics available on complication rates associated with surgery in gynaecological cancer in the UK, apart from data from small studies involving individual centres and clinical trials. This thesis describes the United Kingdom Gynaecological Oncology Surgical Outcomes and Complications study (UKGOSOC) that was set up to prospectively capture data from ten UK gynaecological cancer centres on surgical procedures and complications in a uniform manner using agreed definitions so that data could be analysed and compared. A web-based database was set up to capture surgery and complications contemporaneously from the hospitals, and, consented women were sent a follow-up letter eight weeks postoperatively. Intraoperative and postoperative complications were recorded using a pre-determined list. Postoperative complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from analysis. Univariable and multivariable regression analyses were performed to determine the predictors for intraoperative and postoperative complications. The Lasso method of penalised regression was used to create a risk-prediction model for comparing outcomes between the centres. Data on 2948 eligible major surgical procedures were analysed and 1462 follow-up letters were received. The overall intraoperative complication rate was 4.7% (95% CI 4.0-5.6). The hospital-reported postoperative complication rate was 14.4% (95% CI 13.2-15.7) which increased to 25.9% (95% CI 23.7-28.2) when both hospital and patient- reported postoperative complications were included. The predictors for intraoperative and postoperative complications were different apart from diabetes which was common to both. Risk-adjustment had a modest effect on the complication rates for individual centres but allowed for a fairer comparison. There was no concordance between the ranking order of the centres for intraoperative and postoperative complication rates. The overall intraoperative (≈5%) and postoperative (≈26%) complication rates and funnel graphs derived from this study could be used to benchmark performance of gynaecological oncology centres and even individual surgeons if a larger dataset becomes available nationally.
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Braun, Marcus (Marcus D. ). "Optimal allocation of surgical services." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/90767.
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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2014. In conjunction with the Leaders for Global Operations Program at MIT.<br>Thesis: S.M., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2014. In conjunction with the Leaders for Global Operations Program at MIT.<br>25<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (pages 61-64).<br>Over the past several years Greater Boston has witnessed the consolidation of multiple community hospitals into larger care organizations and a renewed focus on the delivery of affordable care. In order for the Beth Israel Deaconess Medical Center (BIDMc) to respond and adapt to this changing landscape it will be critical to not only understand demand and capacity across the organization's entire network, but also to recognize how the deployment of limited resources can best be improved. From a BIDMc Department of Surgery Perspective, essential business questions include: 1 How to allocate limited existing resources efficiently? 2 Which future growth opportunities should be pursued now? 3 How should a multiple-hospital network be used to meet system demand? Existing approaches employed for solving these questions often involve heuristic rules-of-thumb that fail to treat sunk costs and opportunity costs appropriately. These approaches often lead to demonstrably sub-optimal operational decisions. We have developed a framework for answering these questions in a more quantitatively rigorous fashion using mathematical programming. Our model captures each surgical case's impact on hospital resources (e.g. OR time, surgeon time, etc.) from when a patient enters the preoperative holding area to when they are released from the post anesthesia care unit. Using knowledge of resource requirements for each procedure, we compute an optimal allocation of cases subject to capacity and demand constraints. We pilot our framework by studying three surgical service lines within BIDMC: General Surgery, Colorectal Surgery, and Surgical Oncology. We explore three different approaches to more effectively using resources and determine that the most practical approach yields a potential profit increase of more than 5% over 2012 levels.<br>by Marcus Braun.<br>M.B.A.<br>S.M.
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Mcintosh, Stuart Andrew. "Surgical techniques in breast cancer." Thesis, Ulster University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.626857.
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Surgery forms a key part of the contemporary treatment of breast cancer. Techniques for the surgical management of breast cancer continue to evolve, and in current practice aim to achieve optimal control of the breast tumour while minimising morbidity to tile patient and achieving the best possible aesthetic and quality of life outcomes. Research into specific surgical techniques with these aims was carried out in several hospitals and universities across the United Kingdom. This research focused on two specific areas: sentinel lymph node biopsy (SLNB) in breast cancer, and reconstructive surgery following mastectomy. Feasibility studies were carried out evaluating different techniques for SLNB, examining the role of routine lymphoscintigraphy in SLNB, and the use of SLNB in screen-detected impalpable breast cancer. Immunohistochemical studies were carried out to provide further validation data in support of the sentinel node hypothesis. These studies have informed both clinical practice and the design of subsequent research studies in SLNB. In breast reconstruction, scientific data regarding reconstruction techniques and oncological effects of reconstruction were evaluated, and the issues surrounding the management of breast cancer in the previously augmented breast were assessed. Outcomes in a large series of immediate breast reconstructions utilizing a novel surgical technique were reported, demonstrating that this was a safe and effective technique for immediate reconstruction in both the settings of risk-reducing mastectomy and therapeutic mastectomy for the treatment of breast cancer. Finally, validation data in support of a potential new visualisation tool (stereophotogrammetry) for the objective assessment of aesthetic outcomes in breast reconstruction surgery were described. The work has made a significant contribution to knowledge in both of these fields.
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Xu, Yunwei. "Safety evaluation of surgical instruments." Thesis, University of Dundee, 2017. https://discovery.dundee.ac.uk/en/studentTheses/bfb1e112-315e-4380-ac2b-9457d2f44762.
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Spurred by recent press reports and other concerns this thesis focuses on the quality of surgical instruments. The current situation is reviewed by considering the regulatory framework and by investigating the quality of newly purchased instruments. A range of test protocols based on British Standards and best practices from industry were developed. These were designed to be practical in the real world situation and a user-friendly database was built to collate all the relevant data and inform the Supply Chain. The conditions experienced by instruments during their lifetime in the health care environment, especially in cleaning and disinfection were studied and as many instruments implicated in Incidents as possible investigated to understand the possible root causes of failure. During this work the importance and debate over surface finish, passivation and disinfection processes became apparent and research was carried out into the effect on wettability and drying mechanism of passivation and repeated disinfection cycles on various typical surface finishes. This concentrated on the environment within the health service unlike other studies which have been concerned with more aggressive industrial situations. Standards and Procedures on the care of instruments have been established in order to improve the current management of surgical instruments and to ensure that they are and remain fit for purpose.
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Sheremet, M. I. "Surgical treatment of Hashimoto's thyroiditis." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18639.
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Bondarenko, V. V. "The Da Vinci surgical system." Thesis, Sumy State University, 2014. http://essuir.sumdu.edu.ua/handle/123456789/45545.
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A surgeon may have many problems during and after each surgery, they include: postoperative complications, difficulties during the procedure, long duration of it which causes tiredness of a surgeon. That is why medical engineers invented a new surgical system called da Vinci. It was established in 2010 and has got many supporters since that time.
Using the da Vinci Surgical System, the surgeon has a 3D image inside the patient’s body (it translates from an endoscope, which is equipped with a high quality camera and the light source at the tip). The image from the patient’s body is available on a large monitor (it means that other surgeons can view the procedure and give pieces of advice to the main surgeon). An advantage over the simple laparoscopic procedure is that da Vinci has 3D image, while laparoscopic generally has 2D.
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Ndaule, Eric. "Cataract surgical services in Madagascar." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29835.
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Objective: The main purpose of this study was to evaluate cataract surgical services in Madagascar to help guide the national eye health program. Methods: A retrospective study that used cataract surgical data collected between January 1st and December 31st, 2012 in 8 regional capitals (districts) of Madagascar. 1072 cataract operated eyes from 8 regional capitals supported by Kilimanjaro Centre for Community Ophthalmology (KCCO) satellite centers were analysed. Results: The study findings demonstrated a borderline post-operative visual acuity outcome after 24 hours but showed visual improvements 4 weeks after follow up. Males were more likely to have cataract surgeries compared to females. The cataract surgery rate (CSR) was 1467 in 8 regional capitals of Madagascar. Conclusion: This study demonstrated unequal distribution of cataract surgical services in Madagascar. Therefore, the findings of this study could be used to advocate for equitable provision of cataract surgery across all regions in Madagascar.
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Gostout, Noah Smith. "HeartLander Surgical Feasibility and Commercialization." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1354824891.
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Kerwin, Thomas. "Enhancements in Volumetric Surgical Simulation." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1306163401.
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Arora, Sonal. "Stress, safety and surgical performance." Thesis, Imperial College London, 2010. http://hdl.handle.net/10044/1/11391.
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Sanchez, Erin. "Filtration Efficiency of Surgical Masks." Scholar Commons, 2010. https://scholarcommons.usf.edu/etd/1760.
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Surgical masks are intended to be used to prevent transmission of disease from a health care worker to a patient. Often times, they are relied upon by health care workers for their own protection. In light of recent developments regarding preparation for health care worker response to global infectious diseases such as H1N1 Influenza, health care workers may experience a false sense of security when wearing surgical masks. The goal of this study was to evaluate the filtration efficiency of a double strap tie-on surgical mask. The manufacturer asserts a >95% efficiency with a 0.1 um challenge aerosol under FDA testing procedures. The NIOSH Title 42 CFR Part 84 certification criteria call for testing at a rate of 85 lpm representing a human moderate to heavy work load breathing rate. Three sizes of monodispersed aerosols (polystyrene latex beads: 0.5 um, 1.0 um, 2.0 um) were used.
The specific aims were to measure the collection efficiencies of this mask for the various particle sizes. Two tests were performed. In the first, masks were affixed to a dummy head and the edges of the mask were not sealed. In the second, the edges of the masks were sealed to the head using silicone sealant, so all penetration was through the filtering material of the mask. Differences in upstream and downstream particle concentrations were measured. Thus, penetration by leakage around the mask and through the filtering material was measured. The experimental set up involved passing the aerosol from the nebulizer through a diffusion dryer and Kr-85 charge equilibrator ensuring a dry charge neutralized aerosol cloud for detection by a LASAIR particle counter. The analysis revealed that the filtration efficiency for 0.5 um particles ranged from 3% to 43% for the unsealed masks and 42% to 51% for the sealed. For 1.0 um particles, the efficiency was 58% to 75% for unsealed and 71% to 84% for sealed masks. For 2.0 um, the efficiency was 58% to 79% for unsealed masks and 69% to 85% for the sealed masks. The data were statistically significant and indicated that surgical masks were associated with very low filtration efficiency. This suggests that they may be inadequate against airborne viruses and bacteria.
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Moorthy, Krishna. "The role of simulations in the assessment of surgical proficiency and competence in surgical training." Thesis, Imperial College London, 2004. http://hdl.handle.net/10044/1/7888.
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Marsicano, Daniela. "The association between preoperative anaemia and surgical mortality and morbidity in South African surgical patients." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31104.
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Background: In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa. The demographics of South African surgical patients differ from those of the European and Northern American surgical patients where the preoperative anaemia data are derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to South African surgical patients. Objectives: The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in South African adult noncardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and i) critical care admission, and ii) length of hospital stay, and to describe the prevalence of preoperative anaemia in adult South African surgical patients. Methods: We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS) – a large, prospective, observational study of patients undergoing in-patient noncardiac, non-obstetric surgery at 50 hospitals across South Africa over a one-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis, which included all the independent predictors of mortality and admission to critical care identified in the original SASOS model. Results: The prevalence of preoperative anaemia was 1727/3610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.06-2.60, p=0.028) and admission to critical care (OR 1.49, 95% CI 1.08-2.05, p=0.015). Conclusion: Almost 50% of patients undergoing surgery at government-funded hospitals in South Africa had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear opportunity for quality improvement programmes which may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, it behoves perioperative clinicians in all specialities to educate themselves in the principles of patient blood management.
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Curtis, Merrilyn. "Surgical site infections within the vascular surgical patient : identification of an appropriate index for risk stratification /." [St. Lucia, Qld], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18233.pdf.
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Röjdmark, Jonas. "Microdialysis in reconstructive surgery : a clinical and experimental study focusing on monitoring flap metabolism and viability /." Stockholm, 2000. http://diss.kib.ki.se/2000/20000310rojd/.
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Gulati, Sasha. "Surgical Resection of High-Grade Gliomas." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for laboratoriemedisin, barne- og kvinnesykdommer, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-16444.
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Reseksjon av høygradige gliomer Høygradige gliomer er den vanligste formen for primær hjernesvulst. Glioblastomer (Verdens Helseorganisasjon grad IV) og anaplastiske astrocytomer (Verdens Helseorganisasjon grad III) utgjør mellom 70 og 85 % av høygradige gliomer. Høygradige gliomer er assosiert med både høy morbiditet og mortalitet. Nærmest alle pasienter med høygradige gliomer opplever tilbakefall og dør som følge av sykdommen. Til tross for kirurgi, strålebehandling og cellegift, er median overlevelse for pasienter med glioblastom fremdeles under 12 måneder. For pasienter med anaplastisk astrocytom er median overlevelse 2 til 3 år. Høygradige gliomer infiltrerer omkringliggende hjernevev, og hensikten med kirurgi er, foruten å histopatologisk verifisere diagnosen, å fjerne så mye av svulsten som mulig uten å påføre pasienten nye eller økte nevrologiske utfall. I vår avdeling benytter vi et navigasjonssystem under operasjonene som nyttiggjør tredimensjonale preoperative MR-bilder og tredimensjonal ultralydavbildning under operasjonen. Dette navigasjonssystemet gjør at kirurgen til en hver tid kan se posisjonen til sine instrumenter i forhold til hjernen og svulsten. Ved hjelp av funksjonell MR (eller mer presist blood-oxygenation-level-dependent functional magnetic resonance imaging) og diffusjon tensor traktografi (DTT) kan en henholdsvis kartlegge viktige områder i hjernens grå og hvite substans før operasjonen. Disse undersøkelsene utføres som regel når svulster ligger i nær relasjon til ekstra følsomme områder av hjernen (for eksempel språkområder og viktige områder for bevegelse). Informasjon fra disse undersøkelsene kan også importeres i navigasjonssystemet som benyttes under operasjonen. I de to første studiene i denne avhandlingen ønsket vi å undersøke hvordan funksjonell MR og DTT ble brukt i preoperative vurderinger. Vi evaluerte om funksjonell MR og DTT i kombinasjon med tredimensjonal ultralydavbildning under operasjonen la forholdene til rette for skånsom fjerning av høygradige gliomer beliggende i ekstra følsomme områder av hjernen. I den tredje studien undersøkte vi konsekvensene av kirurgiske komplikasjoner og nevrologiske utfall som følge av kirurgi på glioblastompasienters funksjonsnivå og overlevelse. Videre gjorde vi volumetriske analyser for å beregne hvor mye svulstvev vi klarte å fjerne hos pasienter med primære glioblastomer behandlet i vår avdeling. I den fjerde studien undersøkte vi om det var noen sammenheng mellom overlevelse og fall i selvrapportert livskvalitet kort tid etter kirurgi hos pasienter med glioblastomer. Den femte studien var basert på data fra Kreftregisteret og undersøkte overlevelse og behandling blant eldre pasienter (≥66 år) med glioblastomer over en tyve års periode. Hovedfunnene i denne avhandlingen er: - Kombinasjonen av funksjonell MR, DTT og tredimensjonal ultralydavbildning kan være nyttig når en utfører kirurgisk reseksjon av høygradige gliomer beliggende i ekstra følsomme områder av hjernen. - Pasienter som opplevde komplikasjoner og nevrologiske utfall som følge av kirurgi hadde lavere sannsynlighet for å motta strålebehandling og kjemoterapi. - Tidlig fall i helserelatert livskvalitet etter kirurgi synes å være en sterk og uavhengig negativ prognostisk faktor for pasienter med glioblastom. - Økende alder er en sterk og uavhengig negativ prognostisk faktor for pasienter med glioblastom. Selv om det har vært en intensivering av behandling over tid, har gevinsten i den eldste aldersgruppen vært begrenset. Prognosen for de eldste er fremdeles svært dårlig til tross for multimodal behandling<br>High-grade gliomas are the most common primary brain tumour. Glioblastomas (World Health Organization Grade IV) and anaplastic astrocytomas (World Health Organization Grade III) account for 70-85% of high-grade gliomas. High-grade gliomas are associated with high morbidity and mortality. Virtually all patients with high-grade glioma will experience recurrence and will eventually die from progressing disease. Despite surgery, radiotherapy, and chemotherapy, median survival in patients with glioblastoma still does not exceed 12 months. The median survival for patients with anaplastic astrocytoma (AA) has been reported to be between 2 and 3 years. According to current guidelines, surgery is warranted to establish a histopathologic diagnosis and to achieve safe, maximal, and feasible resection. However, these aggressive tumours cannot be cured and overly aggressive resection is not recommended due to the risk of new neurological deficits. High-grade glioma surgery is a delicate balance between achieving maximal tumour resection and inducing new deficits. In our department a neuronavigation system based on preoperative 3D magnetic resonance imaging (MRI) and intraoperative 3D ultrasound is utilised when resecting high-grade gliomas. Blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI) and diffusion tensor tractography (DTT) are specialized MRI techniques for imaging eloquent cortices and neural tracts in grey and white matter, respectively. The neuronavigation system allows the integration of BOLD fMRI and DTT data if the tumours are located in eloquent regions. In the two first studies of this thesis we sought to investigate the use of BOLD fMRI and DTT for preoperative assessments and determine whether using these data together with 3D intraoperative ultrasound enabled safe resection of high-grade gliomas situated in eloquent regions. In the third study we wanted to explore the impact of surgical morbidity on functional outcome and survival in GBM patients. Further, we sought to determine extent of tumour resection achieved in a consecutive sample of primary GBM from our own department. In the fourth study we wanted to determine if changes in health related quality of life early after surgery could be a predictor for survival in patients with glioblastoma. The aims of the fifth study were to explore survival and the treatment provided to elderly patients (≥66 years) diagnosed with glioblastoma during a 20-year time period in a population-based cohort using the Norwegian Cancer Registry. This thesis investigated the role of surgical resection in the treatment of high-grade gliomas and the following conclusions can be drawn: - The combination of BOLD fMRI, DTT, and 3D intraoperative ultrasound may facilitate resection of high-grade gliomas harboured in eloquent areas while preserving motor and language function. - Functional neuronavigation combined with intraoperative 3D ultrasound can, in most patients, enable resection of brain lesions with general anaesthesia without jeopardizing neurological function. - Patients with perioperative complications and surgically acquired deficits were less likely to receive adjuvant therapy. - Early deterioration in HRQL after surgery was independently and markedly associated with impaired survival in patients with glioblastoma. - Advancing age remains a very strong and independent negative prognostic factor in glioblastoma. Although there has been an increase in the aggressiveness of treatment provided to elderly with glioblastoma, the gain for the oldest age group seems at best very modest. The prognosis of the oldest age group remains very poor, despite multimodal treatment.
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Shah, Jyotiben. "Individual differences in laparoscopic surgical skills." Thesis, Imperial College London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.398000.
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Tong, Irene Go. "Eye gaze tracking in surgical robotics." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/62845.
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Robot-assisted surgery allows surgeons to have improved control and visualization in minimally invasive procedures. Eye gaze tracking is a valuable tool for studying and improving the surgeon experience during robot-assisted surgery. Eye gaze information gives insight on how surgeons are interacting with surgical systems as well as their intentions during surgical tasks. This thesis describes the development of an eye gaze tracker for the da Vinci Surgical System. The eye gaze tracker is designed to track both the 2D and 3D eye gaze of a surgeon. It interfaces with the da Vinci Surgical System through the da Vinci Research Kit (dVRK) and Robot Operating System (ROS) frameworks. The use of the eye gaze tracker is demonstrated in two applications. Firstly, a motor control framework is designed to aid surgeons in moving surgical tools towards their point of gaze. A haptic force is applied to the da Vinci master manipulators to pull the surgeon's hands towards where they are looking. This framework is demonstrated on a full da Vinci Surgical System on dry lab tasks. Secondly, eye gaze information is collected from 7 surgeons performing realistic clinical tasks with the da Vinci Surgical System. A prediction model using a random forest classifier is built based on the eye gaze information and tool kinematic information in order to predict how and when surgeons move their camera. This behavioural model has applications in both surgeon training and endoscope automation.<br>Applied Science, Faculty of<br>Electrical and Computer Engineering, Department of<br>Graduate
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Abitbol, Sarah. "Outcome of non-surgical endodontic treatment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ62996.pdf.
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Boerma, Djemila. "Surgical management of benign biliopancreatic disorders." Amsterdam : Amsterdam : Universiteit van Amsterdam, Faculteit der Geneeskunde ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/57272.
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Usui, Akihiko. "SURGICAL MANAGEMENT OF INFECTED THORACIC ANEURYSMS." Nagoya University School of Medicine, 2013. http://hdl.handle.net/2237/18465.
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Knowles, Jonathan Campbell. "Polymer glass composites for surgical implants." Thesis, Staffordshire University, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.292250.
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Moreira, Tiago Henrique de Egidio. "Incisions : a study of surgical trajectories." Thesis, Lancaster University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274211.
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Hynes, P. "Automatic surgical suturing through visual servoing." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517352.
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