This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patient...This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.展开更多
AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty(TKA).METHODS: We present an imageless navigation system for revision TKA,with optical poin...AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty(TKA).METHODS: We present an imageless navigation system for revision TKA,with optical point and tracker identification to assess kinematic and anatomical landmarks.The system automatically positions the cutting guides with a motorized cutting unit.The cutting unit is placed on the distal femur with a femoral clamp and acts as a rigid body and the base for all femoral cuts.The surgical technique for using the navigation system for revision TKA is based on the technique used in primary TKA.However,there are some important differences.The most notable are:(1) differences in estimation of the position of the primary implant relative to the bone and the mechanical axes;(2) the specific possibilities the revision navigation software offers in terms of optimal joint level positioning; and(3) the suggested "best fit" position,in which the clock position,stem position and offset,femoral component size,and mediolateral position of the femoral component are taken into account to find the optimal femoral component position.We assessed the surgical technique,and accompanying software procedural steps,of the system,identifying any advantages or disadvantages that they present.RESULTS: The system aims to visualize critical steps of the procedure and is intended as a tool to support the surgeon in surgical decision-making.Combining a computer-assisted cutting device with navigation makes it possible to carry out precise cuts without pinning.Furthermore,the femoral clamp provides a stable fixation mechanism for the motorized cutting unit.A stable clamp is paramount in the presence of periarticular bony defects.The system allows the position of the primary implant relative to the bone and mechanical axes to be estimated,at which point any malalignments can be corrected.It also offers an optimal joint level position for implantation,and suggests a "best fit" position,in which the clock position,stem position and offset,femoral component size,and mediolateral position of the femoral component are considered.The surgeon can therefore make decisions intraoperatively to maximise alignment and,hence,outcomes.Based on the intraoperative findings of joint stability,the surgeon can modify the preoperative plan and switch from a constrained condylar system to a hinged version,or vice versa.CONCLUSION: The system is flexible and easy to learn and allows improvements in workflow during TKA.展开更多
In recent years, computer assisted surgery (CAS) systems become more and more common in clinical practices, but few specific design criteria have been proposed for human-computer interface (HCI) in CAS systems. This p...In recent years, computer assisted surgery (CAS) systems become more and more common in clinical practices, but few specific design criteria have been proposed for human-computer interface (HCI) in CAS systems. This paper tried to give universal criteria of HCI design for CAS systems through introduction of demonstration application, which is total knee replacement (TKR) with a nonimage-based navigation system. A typical computer assisted process can be divided into four phases: the preoperative planning phase, the intraoperative registration phase, the intraoperative navigation phase and finally the postoperative assessment phase. The interface design for four steps is described respectively in the demonstration application. These criteria this paper summarized can be useful to software developers to achieve reliable and e?ective interfaces for new CAS systems more easily.展开更多
文摘This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.
基金Supported by Smith and Nephew Gmb H,Marl,Germany
文摘AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty(TKA).METHODS: We present an imageless navigation system for revision TKA,with optical point and tracker identification to assess kinematic and anatomical landmarks.The system automatically positions the cutting guides with a motorized cutting unit.The cutting unit is placed on the distal femur with a femoral clamp and acts as a rigid body and the base for all femoral cuts.The surgical technique for using the navigation system for revision TKA is based on the technique used in primary TKA.However,there are some important differences.The most notable are:(1) differences in estimation of the position of the primary implant relative to the bone and the mechanical axes;(2) the specific possibilities the revision navigation software offers in terms of optimal joint level positioning; and(3) the suggested "best fit" position,in which the clock position,stem position and offset,femoral component size,and mediolateral position of the femoral component are taken into account to find the optimal femoral component position.We assessed the surgical technique,and accompanying software procedural steps,of the system,identifying any advantages or disadvantages that they present.RESULTS: The system aims to visualize critical steps of the procedure and is intended as a tool to support the surgeon in surgical decision-making.Combining a computer-assisted cutting device with navigation makes it possible to carry out precise cuts without pinning.Furthermore,the femoral clamp provides a stable fixation mechanism for the motorized cutting unit.A stable clamp is paramount in the presence of periarticular bony defects.The system allows the position of the primary implant relative to the bone and mechanical axes to be estimated,at which point any malalignments can be corrected.It also offers an optimal joint level position for implantation,and suggests a "best fit" position,in which the clock position,stem position and offset,femoral component size,and mediolateral position of the femoral component are considered.The surgeon can therefore make decisions intraoperatively to maximise alignment and,hence,outcomes.Based on the intraoperative findings of joint stability,the surgeon can modify the preoperative plan and switch from a constrained condylar system to a hinged version,or vice versa.CONCLUSION: The system is flexible and easy to learn and allows improvements in workflow during TKA.
基金the National High Technology Research and Development Program (863) of China(No. 2006AA02A137)
文摘In recent years, computer assisted surgery (CAS) systems become more and more common in clinical practices, but few specific design criteria have been proposed for human-computer interface (HCI) in CAS systems. This paper tried to give universal criteria of HCI design for CAS systems through introduction of demonstration application, which is total knee replacement (TKR) with a nonimage-based navigation system. A typical computer assisted process can be divided into four phases: the preoperative planning phase, the intraoperative registration phase, the intraoperative navigation phase and finally the postoperative assessment phase. The interface design for four steps is described respectively in the demonstration application. These criteria this paper summarized can be useful to software developers to achieve reliable and e?ective interfaces for new CAS systems more easily.
