Analysis of the handling of ophthalmic surgical instruments in hospitals

Background:We investigated the procedures used by medical institutions in Guangdong Province for reprocessing ophthalmic surgical instruments and analyzed the problems identified in order to improve the quality of cleaning medical instruments and its management.Methods:The reprocessing of ophthalmic surgical instruments was investigated in 72 hospitals in Guangdong Province using a questionnaire designed for this purpose.Results:Ophthalmic surgical instruments underwent centralized reprocessing in the disinfection and supply centers in 50%of the 72 hospitals.Cataract phacoemulsification surgery was the main ophthalmic surgery performed in 94%of the 72 hospitals.The main reasons for using centralized reprocessing were an insufficient supply of ophthalmic surgical instruments,short turnaround times between surgeries,and the high cost of losing these precise and fragile instruments.Manual processing was the predominant method of reprocessing ophthalmic surgical instruments;enzyme detergents were used in 63.89%of the hospitals;and 48.61%of the hospitals used N-model small pressure-steam sterilizers for the ophthalmic surgical instruments.Conclusions:In order to improve the quality and management of the cleaning of medical instruments,and guarantee high-quality medical care,the following measures are recommended.Centralized management of ophthalmic surgical instruments should be based on the instruments’characteristics.Pay more attention to reprocessing site locations and staff training.Choose detergents based on manufacturers’instructions for use with specific instruments.Increase the number of available ophthalmic instruments in accordance with their demand and select appropriate small pressure-steam sterilizers.

Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

Background：Magnetic anchored surgical instruments （MASI）,relying on magnetic force,can break through the limitations of the single port approach in dexterity.Individual characteristic abdominal wall thickness （ICAWT） deeply influences magnetic force that determines the safety of MASI.The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT,and then construct an artful method to predict ICAWT,resulting in better safety and feasibility for MASI.Methods：For MASI,ICAWT is referred to the thickness of thickest point in the applied environment.We determined ICAWT through finding the thickest point in computed tomography scans.We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT.Results：Abdominal wall at C point in the middle third lumbar vertebra plane （L3） is the thickest during chosen points.Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness.＂BMI-ICAWT＂ curve was obtained based on abdominal wall thickness of C point in L3 plane,and the expression was as follow：f（x） =P1 × x^2 ＋ P2 x x ＋ P3,where P1 =0.03916 （0.01776,0.06056）,P2 =1.098 （0.03197,2.164）,P3 =-18.52 （-31.64,-5.412）,R-square：0.99.Conclusions：Abdominal wall thickness of C point at L3 could be regarded as ICAWT.BMI could be a reliable predictor of ICAWT.In the light of ＂BMI-ICAWT＂ curve,we may conveniently predict ICAWT by BMI,resulting a better safety and feasibility for MASI.

Analysis and Design of Surgical Instrument Localization Algorithm

With the help of surgical navigation system,doctors can operate on patients more intuitively and accurately.The positioning accuracy and real-time performance of surgical instruments are very important to the whole system.In this paper,we analyze and design the detection algorithm of surgical instrument location mark,and estimate the posture of surgical instrument.In addition,we optimized the pose by remapping.Finally,the algorithm of location mark detection proposed in this paper and the posture analysis data of surgical instruments are verified and analyzed through experiments.The final result shows a high accuracy.

A novel set of surgical instruments facilitate the procedure of laparoscopic pyeloplasty

Background Open pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction （UPJO）, even if new techniques have recently gained a prominent role in this field. Laparoscopic pyeloplasty （LP） is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands. To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model.

Should the Surgical Instrument Parts That Are Broken and Remain in the Distance of the Disc Be Removed? Should It Be Quit? A Case Report

Background and Aim: Lumbar posterior open microdiscectomy is a procedure that is widely used to treat lumbar disc diseases. These operations have a low risk of complications. It is unusual for the tool to break and remain in the intervertebral space during surgery. In this situation, we wanted to provide a set of suggestions based on our research of the literature on pituitary forceps blade fractures and the procedure for removing the fractured portion from the disc space during lumbar posterior open microdiscectomy surgery. Case Presentation: 10 days ago, a 37-year-old female patient presented to our clinic complaining of low back pain, left leg pain, and left foot weakness. A diagnosis of lumbar disc herniation necessitating surgery was obtained following neurological and radiographic examinations. The patient was advised to have surgery. The patient had standard lumbar microdiscectomy surgery. However, the tip of the pituitary forceps was broken during disc removal and remained in the L5-S1 disc space. The scope confirmed that the alien object was in space. After the evaluation, it was decided to remove the piece of instrument that was broken and remained in the disc space. The broken surgical handpiece was removed and documented under fluoroscopy. Additionally, it was forwarded to the technical unit for examination. Conclusion: A few case reports in the literature describe a surgical tool piece fracture that remained in the disc distance of the lumbar microdiscectomy. Complication management may be time-consuming and risky. Such a complication should be addressed and resolved appropriately because this situation might have detrimental terms on surgical risks and the legal procedure.

Safe upper limit of intermittent hepatic inflow occlusion for liver resection in cirrhotic rats

AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was induced by clamping the common pedicle of left and median lobes after non-ischemic lobes resection. The cirrhotic rats were divided into six groups according to the duration and form of vascular clamping: sham occlusion (SO), intermittent occlusion for 10 (IO-10), 15(IO-15), 20(IO-20) and 30(IO-30) minutes with 5 minutes of reflow and continuous occlusion for 60 minutes (CO-60). All animals received a total duration of 60 minutes of hepatic inflow occlusion. Liver viability was investigated in relation of hepatic adenylate energy charge (EC). Triphenyltetrazollum chloride (TTC) reduction activities were assayed to qualitatively evaluate the degree of irreversible hepatocellular injury. The biochemical and morphological changes were also assessed and a 7-day mortality was observed. RESULTS: At 60 minutes after reperfusion following a total of 60 minutes of hepatic inflow occlusion, EC values in IO-10 (0.749 +/- 0.012) and IO-15 (0.699 +/- 0.002) groups were rapidly restored to that in SO group (0.748 +/- 0.016), TTC reduction activities remained in high levels (0.144 +/- 0.002 mg/mg protein, 0.139 +/- 0.003 mg/mg protein and 0.121 +/- 0.003 mg/mg protein in SO, IO-10 and IO-15 groups, respectively). But in IO-20 and IO-30 groups, EC levels were partly restored (0.457 +/- 0.023 and 0.534 +/- 0.027) accompanying with a significantly decreased TTC reduction activities (0.070 +/- 0.005 mg/mg protein and 0.061 +/- 0.003 mg/mg protein). No recovery in EC values (0.228 +/- 0.004) and a progressive decrease in TTC reduction activities (0.033 +/- 0.002 mg/mg protein) were shown in CO-60 group. Although not significantly different, the activities of the serum aspartate aminotransferase (AST) on the third postoperative day (POD(3)) and POD(7) and of the serum alanine aminotransferase (ALT) on POD(3) in CO-60 group remained higher than that in intermittent occlusion groups. Moreover, a 60% animal mortality rate and more severe morphological alterations were also shown in CO-60 group. CONCLUSION: Hepatic inflow occlusion during 60 minutes for liver resection in cirrhotic rats resulted in less hepatocellular injury when occlusion was intermittent rather than continuous. Each period of 15 minutes was the safe upper limit of repeated intermittent vascular occlusion that the cirrhotic liver could tolerate without undergoing irreversible hepatocellular injury.

Five-in-one: a novel, cost-effective yet simple use of micro needle holder

AIM: To achieve a balance between efficiency and cost in the management of medical instrument by the use of micro needle holder. METHODS: In this study, the novel multifunctional use of micro needle holders was performed between 2018 and 2019 at the Department of Ophthalmology in the 4 hospitals in Shaanxi Province. In this innovation, the micro needle holders were initially used as micro forceps to remove sutures, as eye spud to safety extract foreign body from cornea, as ciliary forceps to remove trichiasis, as well as punctal dilator to dilate most small puncta. RESULTS: Using this technique, the medical costs of both procurement and sterilization were cut off in the selected 4 hospitals. The purchase cost has dropped by roughly 50%. The sterilization cost was decreased by about 30%. CONCLUSION: The innovation in the five-in-one multifunctional use of micro needle holders saves the medical costs.

Migration of a Hem-o-Lok clip to the renal pelvis after laparoscopic partial nephrectomy:A case report

BACKGROUND Hem-o-Lok clip(HOLC)has been widely used in laparoscopic surgery due to its ease of application and secure clamping,though the rare complications associated with this technique should not be ignored.The rare complications of laparoscopic partial nephrectomy consist of the clip migrating into the renal pelvis and acting as a nidus for stone formation.CASE SUMMARY The case described here involved a 63-year-old woman who was found with stones in the right kidney and upper ureter during a recent reexamination following laparoscopic partial nephrectomy.We performed percutaneous nephrolithotomy for her,but during the operation,it was found that the center of the stone within the kidney was a HOLC,which was removed with forceps.For this reason,we speculate that the HOLC,which was employed to halt tumor wound bleeding,spontaneously drifted into the renal pelvis and formed kidney stones,with the clip being initially misdiagnosed as a kidney stone.CONCLUSION By reviewing related case reports,we conclude that in order to prevent complications related to HOLC,loose clips should be actively searched for and retrieved from the wound during urinary tract surgery,while the deployment of clips in close proximity of anastomotic stoma of collecting systems should be avoided.

A novel method of removal of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture： a case report

Breakage of surgical instruments and implants during operative procedures is not uncommon in any surgical discipline. The need for removal and the out come of leaving the broken instruments and implants in the surgical area have not been described in detail. Few studies have suggested removal if they are lying loosely in the tis sues or joint, close to neurovascular structures. Challenges and the amount of time spent in the retrieval of broken instruments and implants are well most choose to leave them in known among surgeons, so situ. We reported a novel method of retrieval of a broken drill bit in the femoral medul lary canal during internal fixation of a type C distal femoral fracture.