Tesis sobre el tema "Minimal Invasive Cardiac Surgery"
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Gaffney, Leah. "Cardiac Catheter Brace for Minimally Invasive Surgery". Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17417586.
Texto completoEngineering Sciences
Seco, Michael. "Minimising the Invasiveness of Major Cardiac Surgery". Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/19910.
Texto completoCLERICI, ALBERTO. "Development of a novel technology platform for thoracoscopic aortic valve replacement". Doctoral thesis, Politecnico di Torino, 2019. http://hdl.handle.net/11583/2745352.
Texto completoJegaden, Olivier. "Chirurgie cardiaque mini-invasive : du concept à l'évaluation d'une instrumentation spécifique". Thesis, Lyon 1, 2012. http://www.theses.fr/2012LYO10186/document.
Texto completoThis thesis is based on the evaluation studies of an instrumental platform dedicated to video assisted minimally invasive mitral valve surgery, and of the robotic Da Vinci system in LAD bypass with mammary artery in a closed chest approach. 1) Evaluation of Portaclamp. In 20 patients who underwent cardiac surgery with Portaclamp, a clinical study showed that the clamping system is safe, fast and easy and does not generate undue morbidity. In a pig model, severe lesions of the intima were observed on the clamping spot with the endoclamp, in comparison with Portaclamp and Chitwood clamp. 2) Evaluation of Portapleg. Portapleg is an auto-suturing system dedicated to antegrade cardioplegia delivery, and based on a Nitinol clip left implanted on the aorta. In 20 patients, the closure of the puncture aortic hole and the haemostasis after protamine were obtained in all cases. The procedure did not generate undue morbidity and there was no device-related adverse event. 3) Evaluation of Mitrax’s. The Mitrax’s retractor is a pattern cut polymer sheet, self-expanding and auto-adjusting. The effectiveness of Mitrax’s was evaluated in 62 patients who consecutively underwent a video-assisted mitral valve procedure. The global satisfaction index was 4.6±0.5, demonstrating the effectiveness of the device which provides optimal exposure and excellent direct vision. 4) Comparative analysis of minimally invasive techniques for LAD revascularization with mammary artery graft (Port Access, MIDCAB, TECAB). In a prospective study, 160 patients were included. At 3-month postoperatively, the end-point of LAD reintervention were PA-CABG, 0%; MIDCAB, 1.8%; TECAB, 10%; p=0.01. At 3-year, reintervention-free survival was significantly lower in the TECAB group: PA-CABG, 100% ; MIDCAB, 98±5 % ; TECAB, 88±8 % ; p<0.05
Dill, Rafaela Brittes. "Compensação dos movimentos fisiológicos do coração em cirurgia robótica". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/76168.
Texto completoThis paper refers to the simulation of a control system for a robotic manipulator to compensate the movements of the heart in minimally invasive cardiac surgery. In order to compensate the motion of the beating heart techniques are used to implement a hybrid position/force controller based on data and the movements of the heart obtained in vivo, used as references to the input of the system. Topics modeling robotic manipulators, and in particular, modeling the relationship between forces and displacements on the surface of the heart comprises the structural basis. The role of power control over the position of the manipulator tool on the surface of the heart. It is intended that the main contribution of this study is to show that the hybrid controller follows the restrictions imposed by the dynamics of the heart-lung system.
Osada, Hiroaki. "Novel device prototyping for endoscopic cell sheet transplantation using a three-dimensional printed simulator". Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263545.
Texto completoFares, Charbel. "Simulator for training of the minimal invasive surgery". Marne-la-Vallée, 2006. http://www.theses.fr/2006MARN0290.
Texto completoNowadays there is a growing interest in the computer-based surgical simulation since it has many applications in education, training, surgical planning, and on-line assistance. This project consists of developing a virtual reality environment used for the education of the arthroscopic surgery and for the simulation of the operation on a virtual patient. Its final objective is to assist in real time the operation on a real patient. Three new algorithms are presented: collision detection, Laplacian filter, and penetration depth calculation. The simulator with feedback forces is also presented in details
DYRDA, ALESSANDRO. "Influence of different perfusion and aortic clamping techniques in minimally invasive mitral valve surgery". Doctoral thesis, Politecnico di Torino, 2020. http://hdl.handle.net/11583/2836790.
Texto completoFeuerstein, Marco. "Augmented reality in laparoscopic surgery new concepts and methods for intraoperative multimodal imaging and hybrid tracking in computer aided surgery". Saarbrücken VDM Verlag Dr. Müller, 2007. http://d-nb.info/991301250/04.
Texto completoChristiane, Peter-John. "Development of a minimally invasive robotic surgical manipulator". Thesis, Stellenbosch : Stellenbosch University, 2009. http://hdl.handle.net/10019.1/4497.
Texto completoENGLISH ABSTRACT: Minimal invasive surgery (MIS) enables surgeons to operate through a few small incisions made in the patient’s body. Through these incisions, long rigid instruments are inserted into the body and manipulated to perform the necessary surgical tasks. Conventional instruments, however, are constrained by having only five degrees of freedom (DOF), as well as having scaled and mirrored movements, thereby limiting the surgeon’s dexterity. Surgeons are also deprived of depth perception and hand-eye coordination due to only having two-dimensional visual feedback. Surgical robotics attempt to alleviate these drawbacks by increasing dexterity, eliminating the fulcrum effect and providing the surgeon with three-dimensional visualisation. This reduces the risks to the patient as well as to the surgeon. However, existing MIS systems are extremely expensive and bulky in operating rooms, preventing their more widespread adoption. In this thesis, a new, inexpensive seven-DOF primary slave manipulator (PSM) is presented. The four-DOF wrist is actuated through a tendon mechanism driven by five 12 VDC motors. A repeatability study on the wrist’s joint position was done and showed a standard deviation of 0.38 degrees. A strength test was also done and demonstrated that the manipulator is able to resist a 10 N opposing tip force and is capable of a theoretical gripping force of 15 N.
AFRIKAANSE OPSOMMING: Minimale indringende chirurgie (MIC) maak dit vir chirurge moontlik om operasies uit te voer deur ’n paar klein insnydings wat op die pasiënt se liggaam gemaak word. Deur hierdie insnydings word lang onbuigsame instrumente in die liggaam ingesit en gemanipuleer om die nodige chirurgiese take uit te voer. Konvensionele instrumente is egter beperk vanweë die feit dat hulle net vyf vryheidsgrade het, asook afgeskaalde bewegings en spieëlbewegings, en gevolglik die chirurg se handvaardigheid beperk. Chirurge word ook ontneem van dieptewaarneming en hand-oog-koördinasie, want hulle is beperk tot tweedimensionele visuele terugvoer. Chirurgiese robotika poog om hierdie nadele aan te spreek deur handvaardigheid te vermeerder, die hefboomeffek uit te skakel en die chirurg driedimensionele visualisering te bied. Dit verminder die risiko’s vir die pasiënt én vir die chirurg. Bestaande MIC-stelsels is egter uiters duur en neem baie plek op in teaters, wat verhoed dat hulle op ’n groter skaal gebruik word. In hierdie tesis word ’n nuwe, goedkoop sewevryheidsgrade- primêre slaafmanipuleerder (PSM) voorgelê. Die viervryheidsgrade-pols word beweeg deur ’n tendonmeganisme wat aangedryf word deur vyf 12 VDC-motors. ’n Herhaalbaarheidstudie is op die pols se gewrigsposisie gedoen, wat ’n standaardafwyking van 0.38 grade aangetoon het. ’n Sterktetoets is ook gedoen en het gewys dat die manipuleerder in staat is om ’n 10 N-teenkantelkrag te weerstaan en dat dit oor ’n teoretiese greepsterkte van 15 N beskik.
Kääb, Max Josef. "Möglichkeiten und Grenzen minimal-invasiver Schulterchirurgie". Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2005. http://dx.doi.org/10.18452/13958.
Texto completoGoal of the study was evaluation of advantages and limitations of shoulder diagnosis and different techniques of minimal invasive shoulder surgery. MRI has become the standard for diagnosis of rotator cuff lesions, since it can be difficult to obtain standardized ultrasound images. Goal of the study was analysis of sensitivity of 3D- in comparison to 2D-ultrasound. Examination of 114 patients showed excellent visualization of rotor cuff defects with 3D-ultrasound. Comparison to 2D-ultrasound showed no statistical significant difference between both methods for diagnosis of full- and partial thickness defects of the rotator cuff. Advantage of 3D-ultrasound was the possibility of simultaneous visualization of three standardized planes. For the reattachment of ligaments and tendons biodegradable implants are increasingly used today. However, with the use of biodegradable implants early and late osteolysis has been reported. Goal of this study was to analyze the early osseous integration of a newly designed suture anchor in comparison to a titanium implant. The implants made of Poly-(L-co-D/L-lactide) 70/30 or titanium were inserted into the cancellous bone of the distal femoral condyle in four sheep. The animals were followed radiographically over a period of 20 weeks in which no final implant degradation was anticipated. After sacrifice new bone formation was quantitatively and local tissue response qualitatively analyzed from microradiographs and histological sections were examined. New bone formation was seen around both implant materials within 20 weeks. Inside the recess of the polylactide suture anchor there was significantly higher bony ingrowth (p = 0.026) as compared to the titanium implant. Histologically non of the materials did show any inflammatory reaction. These data indicate that early osteolysis around Poly-(L-co-D/L-lactide) 70/30 suture anchors in cancellous bone may not be attributable to the material properties but rather to other reasons such as the mechanical situation at the implant-bone interface. Arthroscopic subacromial decompression (ASD) has become a well established procedure to treat chronic subacromial impingement syndrome. Goal of the study was to retrospectively evaluate the outcome and to evaluate the validity of data collection by telephone interview. The examination of 422 patients average 4.8 years after peration showed in 75% goog and excellent results. The average Constant score (raw score) improved from 46 to 80 Pts. Patients who had a second ASD had good results in only 25%. Patients with running workers compensation application showed no satisfying outcome. Lesions of the rotator cuff were shown to have no significant influence on the outcome in comparison to patients with intact rotator cuff. Additionally, it was shown that the assessment of various shoulder scores (except Constant Score) by telephone interview is possible. Internal fixators with angular stability have been developed in order to provide high stability without compression of the plate on to the bone. The insertion angle of the screw must correspond precisely to the axis of the screw hole. The objective of this study was to examine the relationship between the stability of the locked screw-plate on the insertion angle of the screw. Locking screws were inserted in a isolated or combined locking hole with the use of an aiming device. The screws were inserted with an axis deviation of 0°(optimal condition), 5° and 10°. The samples were tested under shear or axial (push out) loading conditions until failure occurred. Locking screws inserted in the isolated locking hole (PC-Fix) showed a significant decrease of failure load if inserted at 5° and 10° angle. Screws inserted in the combined locking hole (LCP) also showed a significant decrease of push-out force of 77% with 10° axis deviation. A locking head screw exhibits a high stability with a moderate axis deviation in the angle of insertion of up to 5°. However there is a significant decrease in stability with increasing axis deviation (>5°). A aiming device is recommended to provide an optimal fixation with angular stability. Clinical Examination of 53 patients with angular stable osteosynthesis of proximal humeral fractures showed a rate of complications, which can be compared with literature with lower risk of secondary dislocation. Implants with angular stability allow stable fixation of proximal humeral fractures however the risk of screw perforation is higher.
Winter, Marco. "Image-based incremental reconstruction, rendering and augmented visualization of surfaces for endoscopic surgery = Bildbasierte inkrementelle Rekonstruktion, Darstellung und erweiterte Visualisierung von Oberflächen für die endoskopische Chirurgie". kostenfrei, 2009. http://d-nb.info/1000613615/34.
Texto completoPace, Bedetti Horacio Martin. "The effect of "Postural Freedom" in laparoscopic surgery". Doctoral thesis, Universitat Politècnica de València, 2019. http://hdl.handle.net/10251/122312.
Texto completo[CAT] La cirurgia laparoscòpia està considerada un dels principals avanços quirúrgics en les últimes dècades. Aquesta tècnica ha demostrat nombrosos avantatges comparats amb la cirurgia convencional oberta i ha sigut extensament usada per a processos quirúrgics en l'àrea abdominal. Per al pacient, la cirurgia laparoscòpica suposa diversos avantatges, com per exemple menor dolor post operatiu, temps de recuperació menors, menor risc d'infecció, o reducció del trauma. Per al cirurgià en canvi, la situació és completament diferent, aquesta pràctica requereix major esforç, concentració i estrés mental que la pràctica convencional oberta. A més força al cirurgià a adoptar posicions no-neutres en falanges, mans, nines, i braços. Aquestes postures no-neutres són la principal causa de fatiga muscular i augmenten el risc de problemes musculo-esquelètics. Aquests problemes han sigut àmpliament estudiats per diferents equips d'investigació, els quals estan tractant de millorar l'experiència del cirurgià en el quiròfan. L'enfocament utilitzat en aquest estudi és diferent de l'utilitzat anteriorment per la majoria d'aquests equips, els quals solen proposes solucions basades en canvis ergonòmics amb la intenció de millorar la geometria del mànec de pistola convencional, ja que es considera ergonòmicament deficient. El problema amb aquest enfocament, és que les deficiències no es troben únicament en el mànec, sinó en la utilització d'un punt d'entrada fix que força als cirurgians a mantindre posicions desfavorables. En aquest treball, s'introdueix el concepte "Llibertat Postural" en l'àmbit de la cirurgia, aquest es basa en la hipòtesi que, si les eines no forçaren la posició dels cirurgians, aquests mantindrien posicions més favorables i pròximes al rang de posicions neutres durant els processos laparoscòpics. Els beneficis d'aquest concepte han sigut demostrats per mitjà d'anàlisi de moviment i de electromiografía de superfície, els quals indiquen que la "Llibertat Postural" és causant d'un clar augment de les posicions neutres i de la reducció de la fatiga muscular, i han sigut testats per cirurgians en entorns simulats, els quals troben beneficiós utilitzar la "Llibertat Postural" com a característica base d'aquest nou disseny d'eina laparoscòpica. En la secció final d'aquest treball es proposa un disseny que implementa el concepte de llibertat postura amb el qual es reduiria la fatiga muscular i els problemes *musculo esquelètics associats a la pràctica laparoscòpica. Aquest disseny té la característica d'actuar com una nova secció del braç, sent una articulació que suporta els girs i grans desplaçaments que normalment han de desenvolupar els braços del cirurgià. A més, aquesta solució és econòmica i fàcil de fabricar, la qual cosa permetria el seu ús per cirurgians de tot el món.
[EN] Laparoscopic surgery is considered one of the main surgical advances in the last decades, this technique has demonstrated numerous advantages compared to open conventional surgery and it is widely used in abdominal procedures around the world. For the patient, laparoscopic surgery suppose less post-operative pain, shorter recovery time, lower risk of infection, and reduction of the trauma among other benefits. For the surgeon, the situation is completely different, this practice requires more effort, concentration and mental stress than conventional open procedures. It forces the surgeon to adopt non-neutral postures with phalanges, hands, wrists, and arms being this non-neutral postures the main cause of muscular fatigue and high risk of musculoskeletal disorders. The poor ergonomic postures accelerate muscle fatigue and pain because, outside the neutral range, muscles require more energy to generate the same contractile force than in neutral position. This increase of muscular fatigue is associated with the potential to commit errors that may harm the patient during the surgery. Because this problem is widely studied and different research centers are already trying to improve their surgeons experience in the operation room, the approach used during this work is different than most of the ones presented in previous works. Generally, the solutions proposed are based on ergonomic changes in the handle shape of the instrument, because the conventional pistol-grip handle is considered ergonomically poor. But the problem is not only in the shape of the handle but also in the fixed point of entrance that force the positions for the surgeon despite the handle¿s shape. In this work, the concept of postural freedom in laparoscopic surgery is introduced and evaluated. The postural freedom concept is based on the hypothesis that the surgeon involuntarily would maintain neutral postures if the instrument does not force him or her to reach extreme position with the upper limbs. The benefits of this concept has been demonstrated, by means of electromyography and motion capture. It reduces the localized muscular fatigue and increases the number of neutral postures during laparoscopic simulations. In the final section it is proposed a design that implements the postural freedom concept with, according on the results, the potential to reduce the localized muscular fatigue and the musculoskeletal problems associated to the practice. The design proposed here acts as a new section on the arm, being an articulation that support the turns and big displacements that currently suffer the surgeon¿s body. The solution is affordable and easy to manufacture and could be used by surgeons worldwide.
Pace Bedetti, HM. (2019). The effect of "Postural Freedom" in laparoscopic surgery [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/122312
TESIS
Centurión, Patricio, Carolina Romero, Claudia Olivencia, Ronald Gamarra Garcia y Paul Kaufmann Pardo. "Short-scar facelift without temporal flap: a 10-year experience". Springer International Publishing, 2014. http://hdl.handle.net/10757/612036.
Texto completoMarzok, Mohamed Abdel-Moniem Abdel-Maksoud [Verfasser]. "Minimal invasive phalangeal joints surgery with the aid of the C-arm fluoroscopy technique / submitted by Mohamed Abdel-Moniem Abdel-Maksoud Marzok". Berlin : Mensch-und-Buch-Verl, 2006. http://d-nb.info/979382785/34.
Texto completoDorn, Katja. "Thorakoskopische Untersuchungen am stehenden Rind". Doctoral thesis, Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-139918.
Texto completoObjective: A study on 15 healthy cows was conducted to prove the thoracoscopic technique with the aim to establish a basis for further application of this procedure on cattle. Focus was on developing an adequate examination technique, displaying and describing of physical as well as pathological findings on intrathoracic organs examined endoscopically. Furthermore perioperative complications and indications of this minimally invasive method on cattle should be presented. Methods: The animals underwent a left and right side thoracoscopy under passive lung collapse and under insufflation of CO2. Therefore four thoracoscopies at each cow and a total of 60 thoracoscopies were performed with a waiting time of 24 hours between each examination. The cows were restrained in a stock and locally anesthetized. The endoscopic portal was lined up horizontally with the level of the ventral margin of the coxal tuber, at the point where the local anaesthetic had been injected and varied between the eighth and the tenth intercostal space. After a vertical stab incision through the skin and subcutaneous tissues a blunt stainless teat cannula was introduced into the pleural space. At this point air streamed spontaneously into the pleural space following by an ipsilateral lung collapse. The teat cannula was then removed and replaced by a sharp guarded trocar. After that the trocar was removed and the endoscope was passed through the remaining cannula. The time assessment for examination of each thorax was 20 minutes, started in the cranial pleural space, was continued in the (dorso)-cranial, (dorso)-medial, (dorso)-caudal, ventrocaudal und ventral direction and ended with ventrocranially aligned optic. Results: Most of the intrathoracic organs were seen without additional CO2 insufflation. During left and right side thoracoscopies large parts of the costal pleura, the internal intercostal muscles, the dorsal intercostal veins and arteries, parts of the lungs and the pulmonary ligament, the thoracic aorta, the thoracic part of the esophagus and the longus colli muscle, caudal mediastinal lymph nodes and lymph nodes associated with the dorsal thoracic lymph center, the thoracic part of the sympathic trunk and the dorsal vagus nerve were seen. Furthermore the psoas major muscle, parts of the diaphragm and the cranial phrenic vein, the aortic hiatus, the lumbocostal arch and intermittently the broncho-esophageal artery and vein could be identified. There were some constraints during right side thoracoscopy of the cranial pleural space which caused a limited view at the sympathic nerve fibres associated with the cervicothoracic ganglion, the right costocervical trunk and the right costocervical vein. At the left side these organs, the corresponding left side organs respectively, were constantly seen. Moreover during the exam at the left pleural space the left tracheobronchial lymph node, the brachiocephalic trunk and the left azygos could be well identified. During right side thoracoscopy the right azygos vein was always visible. In one case the presentation of the thoracic duct succeeded as a result of its pathological compression. During examination under passive lung collapse the pericard was visualized in one cow during right side thoracoscopy. The second thoracoscopies of the ipsilateral pleural space were conducted during insufflation of CO2 with a pressure of 5 mm Hg. A stronger lung collapse should result during insufflation with an enhanced view of the organs located intrapleurally. During insufflation at both sides larger parts of the ribs and diaphragm as well as the pericard on the left side at three cattle and on the right side at one cattle could be seen. Postoperative radiographies ensured the absence of an ipsi- or contralateral pneumothorax. Conclusion: This study shows that thoracoscopies on standing healthy cattle could be safely performed without major perioperative complications or side effects. The described minimally invasive procedure is a valuable, gentle and additional method to diagnose intrathoracic diseases in cattle. The use of thoracoscopy as diagnostic tool, for curative and palliative therapy should be identified in further studies
Tschöke, Sven Kevin. "Moderne Behandlungstrategien in der chirurgischen Therapie der pyogenen Spondylodiszitis der Lendenwirbelsäule". Doctoral thesis, Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-211061.
Texto completoSobottka, Stephan B., Gabriele Schackert y A. Steinmetz. "Suitability and Limitations of Pointer-Based and Microscope-Based Neuronavigational Systems for Surgical Treatment of Intracerebral Tumours – a Comparative Study of 66 Patients". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-135186.
Texto completoRahmenfreie Neuronavigationssysteme stellen eine Neuerung in der offenen operativen Behandlung intrazerebraler Tumoren dar. In dieser Studie wurden 66 Patienten mit verschiedenen intrakraniellen Tumoren in unterschiedlichen Lokalisationen mit Hilfe der Neuronavigation operiert. Hierbei wurden zwei verschiedene Navigationssysteme – ein Arm- und Pointer-basierendes System (ISG Viewing Wand) und ein Mikroskop-basierendes System (MKM) – für vier verschiedene Indikationen miteinander verglichen. Die Neuronavigation wurde verwendet (a) bei multiplen Tumoren, wie z.B. Hirnmetastasen, (b) bei solitären kortikalen oder subkortikalen Prozessen in eloquenten Hirnarealen, wie z.B. Motorkortex oder Sprachregion, (c) bei tiefgelegenen Hirntumoren einschließlich Hirnstammtumoren und (d) bei infiltrativ wachsenden Tumoren zur Bestimmung der Tumorgrenzen. Die Verwendung von Hautklebemarkern (MKM-System) und eines Oberflächen-Anpassungsalgorithmus (Viewing Wand) zur Registrierung war mit einer Genauigkeit von 1 bis 2 mm Abweichung für die operative Entfernung aller intrakraniellen Tumoren ausreichend. Beide Systeme bestätigten sich als sichere und geeignete chirurgische Hilfsmittel unabhängig vom Alter der Patienten, der Lagerung des Patienten unter dem chirurgischen Eingriff und der Lokalisation der Raumforderung. Im Systemvergleich zeigte die Viewing Wand durch einen weiten Bewegungsraum des Pointers und der Möglichkeit einer dreidimensionalen Rekonstruktion der Hirnoberfläche Vorteile in der Entfernung von multiplen, in entfernten Hirnregionen gelegenen Tumoren sowie von solitären Prozessen in eloquenter Lokalisation. Das MKM-System war durch die Bereitstellung einer stereotaktischen Führung während des operativen Eingriffes in der Ansteuerung kleiner tiefgelegener Prozesse zu bevorzugen. Eine frühzeitige Liquordrainage führte zu einem brain shifting mit einer diskreten Unterschätzung der wirklichen Tiefe. Für eine genaue Festlegung der Tumorgrenzen von intraparenchymalen Tumoren waren beide Systeme vergleichbar geeignet. Das Relabieren von Hirngewebe in die Resektionshöhle führte jedoch in einigen Fällen von großen intraparenchymalen Tumoren bei beiden Systemen zu einer geringen Überschätzung der wirklichen Tumorgrenzen
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
Sobottka, Stephan B., Gabriele Schackert y A. Steinmetz. "Suitability and Limitations of Pointer-Based and Microscope-Based Neuronavigational Systems for Surgical Treatment of Intracerebral Tumours – a Comparative Study of 66 Patients". Karger, 1998. https://tud.qucosa.de/id/qucosa%3A27627.
Texto completoRahmenfreie Neuronavigationssysteme stellen eine Neuerung in der offenen operativen Behandlung intrazerebraler Tumoren dar. In dieser Studie wurden 66 Patienten mit verschiedenen intrakraniellen Tumoren in unterschiedlichen Lokalisationen mit Hilfe der Neuronavigation operiert. Hierbei wurden zwei verschiedene Navigationssysteme – ein Arm- und Pointer-basierendes System (ISG Viewing Wand) und ein Mikroskop-basierendes System (MKM) – für vier verschiedene Indikationen miteinander verglichen. Die Neuronavigation wurde verwendet (a) bei multiplen Tumoren, wie z.B. Hirnmetastasen, (b) bei solitären kortikalen oder subkortikalen Prozessen in eloquenten Hirnarealen, wie z.B. Motorkortex oder Sprachregion, (c) bei tiefgelegenen Hirntumoren einschließlich Hirnstammtumoren und (d) bei infiltrativ wachsenden Tumoren zur Bestimmung der Tumorgrenzen. Die Verwendung von Hautklebemarkern (MKM-System) und eines Oberflächen-Anpassungsalgorithmus (Viewing Wand) zur Registrierung war mit einer Genauigkeit von 1 bis 2 mm Abweichung für die operative Entfernung aller intrakraniellen Tumoren ausreichend. Beide Systeme bestätigten sich als sichere und geeignete chirurgische Hilfsmittel unabhängig vom Alter der Patienten, der Lagerung des Patienten unter dem chirurgischen Eingriff und der Lokalisation der Raumforderung. Im Systemvergleich zeigte die Viewing Wand durch einen weiten Bewegungsraum des Pointers und der Möglichkeit einer dreidimensionalen Rekonstruktion der Hirnoberfläche Vorteile in der Entfernung von multiplen, in entfernten Hirnregionen gelegenen Tumoren sowie von solitären Prozessen in eloquenter Lokalisation. Das MKM-System war durch die Bereitstellung einer stereotaktischen Führung während des operativen Eingriffes in der Ansteuerung kleiner tiefgelegener Prozesse zu bevorzugen. Eine frühzeitige Liquordrainage führte zu einem brain shifting mit einer diskreten Unterschätzung der wirklichen Tiefe. Für eine genaue Festlegung der Tumorgrenzen von intraparenchymalen Tumoren waren beide Systeme vergleichbar geeignet. Das Relabieren von Hirngewebe in die Resektionshöhle führte jedoch in einigen Fällen von großen intraparenchymalen Tumoren bei beiden Systemen zu einer geringen Überschätzung der wirklichen Tumorgrenzen.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
Rückert, Jens-Carsten. "Die Entwicklung der thorakoskopischen Thymektomie". Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2003. http://dx.doi.org/10.18452/13884.
Texto completoThe aim of the present work was to develop and evaluate a novel operation technique to perform a complete thymectomy (Thx). This new approach was first used in a clinical setting in 1994. The thoracoscopic approach for Thx was developed at the Humboldt University Medical School (Charité), Clinic of Surgery, Campus Mitte according to the principles of "good clinical practice" for the introduction of a new operation technique. The success of conventional Thx for MG was determined by a retrospective cohort study as an internal standard. The results of our own clinical series at the Charité corresponded with the data of large published series worldwide and, were thus representative for the aim of developing a new operation technique. Apart from the approval of feasibility, the complex evaluation of the new surgical approach comprised an experimental anatomical study to demonstrate adequate radicality. It could be shown that a unilateral left-sided thoracoscopic operation technique with only 3 trocars can better accomplish a complete Thx as compared to a right-sided 3-trocar-technique. The next step was the development of the detailed and standardized operation technique for the clinical application of thoracoscopic Thx (tThx) which considers the individually different anatomical circumstances and is described. After encouraging first results, the findings of the prospective clinical investigation of the procedure in the first 60 patients were presented, standardized according to the suggestions for clinical research of the Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. The hypothesis of smaller impairment and faster recovery of pulmonary function after tThx was investigated and could be proved in a prospective comparison of tThx versus the most accepted and most common approach for Thx.Consequently, the results of functional improvement of MG after tThx, median sternotomy for Thx, and anterolateral thoracotomy for Thx were compared in a matched-pair study. Though technically demanding, tThx showed adequate results combined with objective and subjective patient-related advantages. For ethical and epidemiological reasons and due to the pathogenesis of MG a single-center study design with higher level of evidence seems difficult to achieve. In conclusion, tThx may solve the dilemma of the search for an optimal operation technique for Thx because minimal invasion is obtained by an optimal approach with only 3 trocars. This creates the possibility of radical Thx by wide exposure of the anterior mediastinum. The technique of tThx should be prefered because an adequate rate of improvement of MG is achieved by a minimally-invasive operation technique. The comprehensive investigation of this technique should be continued.
Lin, Tzu-Yung y 林子鏞. "Factors influencing the pain-relieving effect of bupivacaine local infusion in the wound after minimally invasive cardiac surgery". Thesis, 2009. http://ndltd.ncl.edu.tw/handle/33529908437752275485.
Texto completo元智大學
機械工程學系
97
Patients undergoing cardiac surgery often dread the upcoming pain after surgery. The pain associated with cardiac surgery requiring sternotomy or thoracotomy originates from skin incisions, fractured sternum or ribs, parietal pleura and costoverterbral joint injury. Infusion of local anesthetics in the wound is a simple and safe method of pain control. It has been tested in various site and proved to be effective in iliac crest harvest site, sternotomy of cardiac surgery, thoracotomy after lung surgery, and hysterectomy. The main purposes of this study were to assess the effect of local wound infusion of local anesthetics on pain control in the thoracotomy wound of patients undergoing minimally invasive cardiac surgery, to disclose the factors determining the pain-controlling effect of bupivacaine wound infusion, including the concentration of bupivacaine, infusion rate, and location of infusion. Besides of acute pain, we also investigate if different duration or timing of local anesthetics administration would modify the pattern of chronic wound pain, and to investigate the effect of bupivacaine local infusion at sternotomy after off-pump coronary bypass grafting surgery on postoperative inflammatory cytokine surge. Patients who underwent coronary artery bypass grafting or cardiac valvular procedures via a minimally invasive thoracotomy were studied. Patients were enrolled and randomly allocated to two groups with different modalities of postoperative analgesia. In the first part, the thoracotomy wound infusion group received 0.15% bupivacaine infused continuously at 2 mL/h through a catheter embedded in the wound, as well as intravenous patient-controlled analgesia. The control group had patient-controlled analgesia alone with a sham thoracotomy wound infusion of normal saline. Verbal analog pain scores (0–10 points) and recovery profiles were investigated. There were 19 patients in each group for complete data analysis. In this controlled double-blind study, thoracotomy wound infusion and patient-controlled analgesia was superior to patient-controlled analgesia alone in reducing pain at 1, 3, and 90 days after minimally invasive cardiac surgery. Second, we used 0.375% and 0.5% of bupivacaine or 2 mL/hr and 5 mL/hr to the patients to assess the effect of concentration and rate. Among these patients, there was no significant difference in both demographic data and perioperative characteristics. Third, we collected ten patients’ data and analyzed bupivacaine concentration in plasma by HPLC. All of them had 0.375% bupivacaine infused at 2ml/hour after operation. There was an increased trend from 24 to 48 hours after the operation. Forth, we also evaluate the inflammatory reaction by analyzed IL-8 and IL-10 concentration in plasma via ELISA. These patients were divided into two groups: 0.375% bupivacaine infused at 5ml/hour and normal saline. Individual variance was caused significant difference among time points. However, the trend of bupivacaine group was higher than saline group in IL-8, but the IL-10 was similar. In the future, we want to find out the optimal concentration and infusion rate of local anesthetics wound infiltration in cardiac surgery and compare the pain relief effect of other alternative procedures or drugs. Besides, the anti-inflammation and antimicrobial effect was also noted in the in-vitro study, we try to construct an animal model and using the continuous infusion of local anesthetics methods in this model which may be helpful in this study. If this animal model is proved effective, maybe we can promote the continuous local anesthetics infiltration methods in cardiac surgery not only in pain relief, but also in the prevention of wound infection which was a major complication of cardiac surgery.
BENDOVÁ, Miroslava. "Role sestry a specifika ošetřovatelské péče u miniinvazivních kardiochirurgických výkonů". Master's thesis, 2015. http://www.nusl.cz/ntk/nusl-188686.
Texto completoMazine, Amine. "Chirurgie mitrale minimalement invasive : évolution historique et bénéfices cliniques". Thèse, 2014. http://hdl.handle.net/1866/12119.
Texto completoLa sternotomie médiane est l’approche classique pour la chirurgie de la valve mitrale. Elle permet une exposition optimale, mais est associée à un traumatisme chirurgical important, car elle requiert la séparation de l’os sternal. Le présent mémoire porte sur une solution alternative à la sternotomie dans le contexte de la chirurgie mitrale : la chirurgie minimalement invasive (CMI) par minithoracotomie antérolatérale. Trois études ont été réalisées dans le cadre de ce travail. Dans un premier temps, une étude de cohorte regroupant 200 patients consécutifs a permis d’évaluer le taux de succès des réparations mitrales réalisées par minithoracotomie et d’évaluer la durabilité de ces réparations à moyen terme. Par la suite, une étude comparative a été réalisée afin d’évaluer deux méthodes de clampage aortique pour la CMI, soit l’occlusion endovasculaire avec ballon et l’occlusion transthoracique. Enfin, une étude avec analyse par score de propension (propensity score) a permis de comparer la CMI à la sternotomie en ce qui a trait à une complication fréquente en chirurgie cardiaque, l’insuffisance rénale aiguë. La première étude a permis de conclure que la CMI peut être réalisée avec un taux de réparation quasi parfait, et ce malgré la courbe d’apprentissage associée à la technique minimalement invasive. Ces réparations semblent être durables, tel que démontré par une survie sans réopération de 98.3 ± 1.2% à 5 ans. La seconde étude a permis de démontrer que l’occlusion transthoracique est plus fiable que l’occlusion endoaortique et qu’elle est associée à des temps opératoires diminués et à une plus faible incidence de complications procédurales. Enfin, la troisième étude a démontré une association significative entre la CMI et une diminution du risque d’insuffisance rénale aiguë. En conclusion, la minithoracotomie antérolatérale est une excellente alternative à la sternotomie médiane. Tout en diminuant le traumatisme chirurgical, cette approche ne compromet pas la qualité de l’acte chirurgical et présente des bénéfices cliniques.
Median sternotomy is the classic approach for mitral valve surgery. This technique allows optimal exposure but is considered invasive as it requires section of the sternal bone. This thesis discusses an alternative sternotomy : minimally invasive mitral valve surgery (MIMVS) through a right anterolateral minithoracotomy. Three studies were conducted as part of this work. First, a cohort study involving 200 consecutive patients was used to evaluate the success rate of mitral valve repairs performed by minithoracotomy and assess the midterm durability of these repairs. Second, a comparative study was conducted to evaluate two methods of aortic clamping for MIMVS, namely the endovascular balloon occlusion technique and the transthoracic occlusion approach. Finally, a propensity score analysis study was performed to compare MIMVS and sternotomy with respect to a common complication following cardiac surgery : acute renal failure. The first study demonstrated that MIMVS can be performed with a near perfect repair rate, despite the learning curve associated with the minimally invasive technique. These repairs appear to be durable, as evidenced by a freedom from reoperation rate of 98.3 ± 1.2% at 5 years. The second study demonstrated that transthoracic clamping is more reliable than endoaortic occlusion and is associated with shorter operative times and a lower incidence of procedural complications. Finally, the third study found a significant association between MIMVS and a decreased risk of postoperative acute renal failure. In conclusion, the anterolateral minithoracotomy appraoch is an excellent alternative to median sternotomy. While decreasing surgical trauma, this approach does not compromise the quality of surgery and is associated with important clinical benefits.
El, Yamani Nidal. "Interventions innovantes dans le traitement des maladies valvulaires mitrales et aortiques : options de traitement actuelles et perspectives futures". Thesis, 2020. http://hdl.handle.net/1866/25185.
Texto completoValvular heart disease is an important cause of morbidity and mortality. In western countries, mitral regurgitation and aortic stenosis are the most frequent valvular pathologies and their prevalence increases with age. With the increase in life expectancy in these countries, the prevalence of degenerative valve disease will increase with a significant burden on healthcare systems. Advances in cardiac surgery as well as new breakthroughs in interventional cardiology have considerably modified the management of patients with valvular disease, by offering minimally invasive approaches, especially for patients at high surgical risk. In this thesis, two retrospective cohort studies were carried out. The first compares the postoperative and 3 years outcomes of mitral valve surgery vs MitraClip, a transcatheter procedure, in 259 patients with severe ischemic mitral regurgitation. The second study compares the postoperative results of two minimally invasive techniques (ministernotomy and minithoracotomy) for aortic valve replacement to conventional sternotomy. In the first study, MitraClip procedure had lower postoperative and 3-year mortality rate than surgery, but it was associated with higher recurrence rate of mitral regurgitation after 3 years. The second study showed that the two minimally invasive approaches had similar intrahospital mortality rate to sternotomy. Minithoracotomy was associated with less perioperative bleeding and less pain at rest than sternotomy. In conclusion, minimally invasive approaches offer an excellent alternative to conventional surgery in the treatment of valvular disease. The clinical benefits are more highlighted when patients are properly selected; hence the importance of a "Heart Team" that collaborates for better patient care.
Sheng-ChiehHuang y 黃聖傑. "Electromagnetic thermotherapy system for minimal invasive surgery and organ resection surgery". Thesis, 2010. http://ndltd.ncl.edu.tw/handle/12491082394969089902.
Texto completo國立成功大學
工程科學系碩博士班
98
Cancer and trauma are still major threats to people, and therapy for these threats needs further improvement. The use of electromagnetic thermotherapy systems in surgery offers new hope for these patients. We conducted in vitro and in vivo experiments to assess the feasibility of this new form of thermotherapy. In our experiments, a two-part needle was used for minimal invasive surgery, and a needles array was used for organ resection surgery. We developed a system which can generate a high-frequency alternation magnetic field designed to induce a localized temperature increase induced by inserting needles into the target tissue. To prevent overheating, a feedback temperature control system was successfully developed to keep the needles at a constant temperature. First, for in vitro tests, the relationship between the coagulation zone and the temperature and time factors were investigated. The needles were coated with Teflon to prevent them from sticking to the tissue. By using a feedback temperature control system, the needles could be heated up to specific temperatures, 42, 60 and 80oC, respectively. With this approach, we found the temperature and time necessary for coagulation in both minimal invasive surgery and in organ resection surgery. For in vivo tests, in an internal medicine environment, a New Zealand white rabbit’s liver was coagulated using a two-part needle. In the organ resection surgery, the liver of a New Zealand white rabbit and a Lan-Yu pig’s liver, spleen and pancreas were resected using the needle array. The experiments showed that by inserting the two-part needle and needles array into the target tissue, applying our electromagnetic thermotherapy system resulted in coagulation in the liver and resection of the organs without bleeding, which is very promising for further clinical use.
Vilaça, Jaime Daniel Pacheco Martinho. "Minimal invasive surgery: contribution of three dimensional image on single-site endoscopic surgery". Doctoral thesis, 2021. http://hdl.handle.net/1822/75788.
Texto completoOs sistemas endoscópicos são usados em medicina ha mais de duzentos anos. Durante as três últimas décadas houve um esforço tecnológico considerável para desenvolver sistemas de imagem tridimensional para uso em cirurgia endoscópica. Os atuais sistemas disponíveis têm alta definição de imagem e são fáceis de usar, pois apenas necessitam que o cirurgião coloque uns óculos leves com lentes polarizadas. A cirurgia por acesso único apareceu no início deste milénio como uma proposta para diminuir ainda mais o trauma da cirurgia endoscópica e melhorar o resultado estético. Combinando este dois elementos, colocou-se a hipótese que a imagem 3D pudesse melhorar o desempenho na execução de procedimentos por acesso único. O principal objetivo desta tese é comparar em ambiente laboratorial o desempenho de principiantes e de cirurgiões experimentados na execução de cirurgia por acesso único usando sistemas de imagem 3D e 2D. Para cumprir este objetivo, dois estudos foram realizados, o primeiro usando exercícios validados com modelos inanimados e o segundo, um modelo orgânico. Vantagens na execução, aprendizagem e preferencia pelo sistema 3D foram significativas, e os resultados foram publicados. Para além disso, uma revisão baseada na evidencia foi feita para avaliar os possíveis benefícios clínicos da imagem 3D em cirurgia endoscópica de múltiplas portas. Ganhos na execução, curva de aprendizagem e redução do cansaço em favor do uso 3D foram encontrados. Nesta tese, o conhecimento destas áreas é revisto, a evolução tecnológica, as indicações para cirurgia de acesso único e as perspectivas futuras são criticamente analisadas. Conclui-se que a cirurgia por acesso único tem sido um motor de desenvolvimento na cirurgia minimamente invasiva e que a imagem 3D possivelmente beneficia a maioria dos executantes independentemente da sua experiência.
Endoscopic systems are more than 200 years old and have always relied on a two-dimensional image. In the late 1980´s, the advent of video-assisted surgery ushered in the era of minimally invasive surgery. The past three decades have seen a technological effort to provide endoscopic surgery with three-dimensional imaging. Currently 3D systems are high definition and easy to use with polarized and lightweight glasses. Single-site surgery is a proposal to further reduce trauma and improve the aesthetic result of endoscopic surgery, an option that started to develop at the beginning of this millennium. Combining these two elements, we hypothesize that a 3D imaging system can bring about better performance in executing single-site endoscopic procedures. The main objective of this thesis is to compare the performance of beginners and experts in a laboratory environment while conducting single-site surgery using a 3D system or a 2D system. To this end, two studies were carried out, using validated phantom exercises and an organic model. Benefits in performance, learning and user preference proved significant, and the results were published. Apart from this, an evidence-based review was carried out to assess the possible clinical benefits of 3D technology in multi-port endoscopic surgery. Gains in execution, learning curve and decreased workload were found. In this thesis, the knowledge of this area is reviewed, along with the technological evolution, the indications for single-site surgery and critical analysis of its foreseeable future implementation. We conclude that single-site surgery has been a driver for the development of minimally invasive surgery and that a 3D image likely benefits most performers regardless of their experience.
Hiegel, Joana. "Evaluation of minimal access proximal thoracic aortic surgery". Doctoral thesis, 2017. https://ul.qucosa.de/id/qucosa%3A16683.
Texto completoGofus, Ján. "Vliv miniinvazivního přístupu na respirační funkce u pacientů po aortální náhradě". Doctoral thesis, 2021. http://www.nusl.cz/ntk/nusl-438373.
Texto completoLeong, Iat-Fai y 梁日輝. "A Kinematic Animation System for Medical Robot Design Using in Minimal Invasive Surgery". Thesis, 2000. http://ndltd.ncl.edu.tw/handle/07808606365759777248.
Texto completo國立成功大學
機械工程學系
88
In order to overcome the problems encounter by National Cheng Kung University Hospital during Minimally Invasive Surgery (MIS) in CT room. These problems include the difference of spatial perception among doctors and the training schedule of residency. For the first problem, we use medical robotic system to perform puncture operation. This result turns out a much better accuracy then traditional MIS. Medical doctors are able to monitor and control the whole process via see-through the virtual environment and a force feedback controller. Furthermore, this system can be extended to become a tutorial instrument. Virtual reality techniques are employed to examine the medical robots and simulate minimally invasive surgery. A CT scanning environment based on the actual scanning room located in NCKUH was constructed as a virtual operation environment. Our tasks include building a virtual environment, synthesizing the dimensions of various robots that capable to perform the operation. Path planning for the designed robot directs the Needle Insertion System(NIS) to the puncture position. CT images are utilized as a guiding tool for pin-point the tumor area. In this thesis, we presented three candidate robots, the Cartesian Robot, the SCARA-like Robot and the Arc-shaped Robot. After the evaluations in the virtual environment, the Cartesian Robot is selected to be fabricated as the first prototype. This system used TCP/IP to transfer data between the force feedback controller and the animated virtual environment. Medical doctors are capable to sense the reaction force while inserting the needle into the patient’s body. With the assistance of force feedback controller, doctors are able to sense whatever has gone wrong. With all the tools and techniques mentioned above, this system provides an accurate method to perform puncture operation, which would reduce the radioactive doses taken by both patient and the surgical team. Virtual reality can also be used as a pre-surgical plan, and as a monitor system during MIS in CT room.
Chia-Chum, Hsu y 許嘉峻. "Design and Implement of The Needle Insertion Force Feedback Mechanism Using in Minimal Invasive Surgery". Thesis, 2000. http://ndltd.ncl.edu.tw/handle/07875503493905798395.
Texto completo國立成功大學
機械工程學系
88
The purpose of the research is to develop a Virtual Reality (VR) force feedback system using in Minimally Invasive Surgery (MIS) for abdomen. This design is to teleoperate the process of needle puncture on a medical robotics for tumor removal from liver. In this thesis, related work has been classified into four topics, which includes virtual reality, force feedback, human hand tactile, and tactile feedback in medical applications. According to the predecessor’s experiences, we designed the force feedback device and developed the control system. Firstly, we make a puncture experiment on sample models to obtain the force domains. According to the design requirements and design limit, we made several different designs for evaluation. We selected one of the designs - magnetic break for advance design and production. A control software, named LabView was employed to connect between the hardware and system. It includes data acquisition, force simulation, and puncture resistant display. The position information has been transmitted from encoder. The feedback force is calculated from the position information and experimented force models in order to illustrated on the force feedback device. We investigate the integrated system by two of the research work. Finally, the system is then built to integrate with virtual puncture visual system via TCP/IP, to assist pre-surgical plan and surgical simulation. The force feedback system described in this paper is one of the subsystems in minimal invasive surgery in CT room. The puncture robotics and virtual surgical visualization system are integrated to a complete MIS surgical simulation system in near feature.
Chiu, Yi-Chun y 邱逸淳. "Qualitative and Quantitative Micro Raman Spectroscopy Identification of Urinary Stone Composition after Minimal Invasive Urological Surgery". Thesis, 2010. http://ndltd.ncl.edu.tw/handle/86290254162177166314.
Texto completo國立陽明大學
醫學工程研究所
98
Urolithiasis is a common disease with high recurrent rate. Identification of urinary stone composition is important for metabolic evaluation, decision-making and diet control. Traditional urinary stone analytic methods need large stone fragments for analysis. However, with the advancement of ureteroscopic lithotripsy (URSL) or extracorporeal shockwave lithotripsy (ESWL) has resulted in micro stones and unapparently expelled urinary stone powders. We aim to develop a micro-Raman Spectroscopy (MRS)-based method for detecting the composition of micro-stones or stone powders in urine after minimal invasive urological surgery (MIUS). First we establish the Raman spectra database for prevalent standard compounds and then we measure the post operative stones. MRS-based approach reveals comparable and even more detailed analytic result than Fourier transform infrared spectroscopy (FTIR). We also successfully analyze the composition of urinary stone powders directly from the urine samples in post-URSL urine. And then quantitative analysis is based on the construction of calibration curves of known mixtures of synthetically prepared standard compounds. The various concentration ratio of binary mixtures were produced and used as the basis for the quantitative analysis. Intensities of the characteristic bands were used for calculation. The ratios of the relative intensities of Raman bands corresponding to binary mixtures of known composition and content concentration yielded a linear dependence. This bench-to-besides MRS-based approach provides a quick and convenient method for micro urinary stone analysis in both qualitative and quantitative aspect.
Lin, Tsung-Ching y 林宗慶. "The results and effect of minimal invasive total knee replacement surgery: the discussion of kinetic analyses and functional recovery". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/17707269407943452027.
Texto completo國立臺灣師範大學
運動科學研究所
99
Purpose: To investigate the kinetic parameters of lower limb and nature course of functional recovery of the patient who underwent the minimal invasive total knee replacement surgery and determine the change of maximal torque in knee flexors and knee extensors at different muscle strength testing condition. Methods: In this prospective study, twenty-two participants underwent the unilateral minimal invasive total knee replacement surgery, and the knee extensors, knee flexors muscle strength were evaluated at five different times: before surgery, post surgery 1th, 2th, 6th and 12th month. Isometric, isokinetic muscle strength, range of motion(ROM), joint sense and rate of force development(RFD) were analyzed. Results: There is significant difference in isokinetic muscle strength of knee extensor and ROM between both sides before surgery. On post surgery 1st and 2nd month, the maximal torquethe of knee extensor in the operative side were significant smaller than the non-operative side at isometric testing in 60°, and isokinetic test at 60°, and 180° angular velocity. There is no significant difference between post surgery 2nd month and pre surgery in operative side.Only isokinetic 180° the maximal torque of knee extensors in non-operation side was greater than the operation side. 0-150ms RFD of operative leg is significant smaller than non-operative leg duing post surgery 1th, 2th, 6th and 12th month.Conclusion: This study concluded that there was a significant decreased maximal torque of operative leg at one month after surgery compare with the value before surgery; The muscle strength of operative leg can recover to the level before surgery at post surgery 2nd month;There is still lower muscle strength of fast msucle in operative leg than non-operative leg at post surgery 6th month.The values of RFD in operative leg is always lower than non-operative leg during post surgery 1 year.This conclusion could be the reference for the exercise scientists or other exercise experts to design the exercise equipment and exercise prescription.
PRUCHER, GIAN MARCO. "Nuove applicazioni terapeutiche e strumentali nel trattamento delle patologie non neoplastiche delle ghiandole salivari mediante scialoendoscopia". Doctoral thesis, 2021. http://hdl.handle.net/11573/1569463.
Texto completoHuang, Yu-Chen y 黃郁蓁. "The Study on the Inter-organizational Learning and Knowledge Transferring Mechanism: A Case of Minimal Invasive Surgery Center of S Regional Hospital". Thesis, 2010. http://ndltd.ncl.edu.tw/handle/14624526166714356129.
Texto completo亞洲大學
國際企業學系碩士班
98
Since 1995, National Health Insurance Policy has been established in Taiwan which brings in an overall medical environment change. To confront with the operational difficulties brought up by these changes, managers in hospitals have adaptively tried to adjust their operational strategies in accordance with the hospital’s existing conditions such as strategic alliance, outsourcing, chain management, and inter-organizational relationship management. Their goal is to continuously develop and survive within the changing environment. By using the qualitative depth interview and participant observation research methods, this study adopted minimal invasive surgery center of S regional hospital in Taiwan as the case for study. The goal of this study is to explore the inter-organizational learning and knowledge transferring mechanisms, and possible issues generated. In accordance with the analytical results, the authors induced three constructs: knowledge transferring mechanism, learning disorders, and learning effects of inter-organization. In short, it summarized the knowledge transferring mechanism developed by S hospital during inter-organizational learning, issues confronted, and described on inter-organizational learning effects.
Dorn, Katja. "Thorakoskopische Untersuchungen am stehenden Rind". Doctoral thesis, 2013. https://ul.qucosa.de/id/qucosa%3A12407.
Texto completoObjective: A study on 15 healthy cows was conducted to prove the thoracoscopic technique with the aim to establish a basis for further application of this procedure on cattle. Focus was on developing an adequate examination technique, displaying and describing of physical as well as pathological findings on intrathoracic organs examined endoscopically. Furthermore perioperative complications and indications of this minimally invasive method on cattle should be presented. Methods: The animals underwent a left and right side thoracoscopy under passive lung collapse and under insufflation of CO2. Therefore four thoracoscopies at each cow and a total of 60 thoracoscopies were performed with a waiting time of 24 hours between each examination. The cows were restrained in a stock and locally anesthetized. The endoscopic portal was lined up horizontally with the level of the ventral margin of the coxal tuber, at the point where the local anaesthetic had been injected and varied between the eighth and the tenth intercostal space. After a vertical stab incision through the skin and subcutaneous tissues a blunt stainless teat cannula was introduced into the pleural space. At this point air streamed spontaneously into the pleural space following by an ipsilateral lung collapse. The teat cannula was then removed and replaced by a sharp guarded trocar. After that the trocar was removed and the endoscope was passed through the remaining cannula. The time assessment for examination of each thorax was 20 minutes, started in the cranial pleural space, was continued in the (dorso)-cranial, (dorso)-medial, (dorso)-caudal, ventrocaudal und ventral direction and ended with ventrocranially aligned optic. Results: Most of the intrathoracic organs were seen without additional CO2 insufflation. During left and right side thoracoscopies large parts of the costal pleura, the internal intercostal muscles, the dorsal intercostal veins and arteries, parts of the lungs and the pulmonary ligament, the thoracic aorta, the thoracic part of the esophagus and the longus colli muscle, caudal mediastinal lymph nodes and lymph nodes associated with the dorsal thoracic lymph center, the thoracic part of the sympathic trunk and the dorsal vagus nerve were seen. Furthermore the psoas major muscle, parts of the diaphragm and the cranial phrenic vein, the aortic hiatus, the lumbocostal arch and intermittently the broncho-esophageal artery and vein could be identified. There were some constraints during right side thoracoscopy of the cranial pleural space which caused a limited view at the sympathic nerve fibres associated with the cervicothoracic ganglion, the right costocervical trunk and the right costocervical vein. At the left side these organs, the corresponding left side organs respectively, were constantly seen. Moreover during the exam at the left pleural space the left tracheobronchial lymph node, the brachiocephalic trunk and the left azygos could be well identified. During right side thoracoscopy the right azygos vein was always visible. In one case the presentation of the thoracic duct succeeded as a result of its pathological compression. During examination under passive lung collapse the pericard was visualized in one cow during right side thoracoscopy. The second thoracoscopies of the ipsilateral pleural space were conducted during insufflation of CO2 with a pressure of 5 mm Hg. A stronger lung collapse should result during insufflation with an enhanced view of the organs located intrapleurally. During insufflation at both sides larger parts of the ribs and diaphragm as well as the pericard on the left side at three cattle and on the right side at one cattle could be seen. Postoperative radiographies ensured the absence of an ipsi- or contralateral pneumothorax. Conclusion: This study shows that thoracoscopies on standing healthy cattle could be safely performed without major perioperative complications or side effects. The described minimally invasive procedure is a valuable, gentle and additional method to diagnose intrathoracic diseases in cattle. The use of thoracoscopy as diagnostic tool, for curative and palliative therapy should be identified in further studies.
Süß, Malte. "Therapie breitbasiger Adenome und der pT1-low-risk-Karzinome des Rektums". Doctoral thesis, 2005. http://hdl.handle.net/11858/00-1735-0000-0006-AF24-E.
Texto completoWyszkowski, Agatha. "Knochenregeneration mit mikrofixierten Titanbarrieren an zahnlosen und implantattragenden Kieferabschnitten". Doctoral thesis, 2010. http://hdl.handle.net/11858/00-1735-0000-000D-F0DF-A.
Texto completo