Begell House Inc.
Journal of Long-Term Effects of Medical Implants
JLT
1050-6934
13
5
2003
Outstanding Scientist of 2003: Dr. Zhong Wei Chen, A Microsurgery Pioneer
4
10.1615/JLongTermEffMedImplants.v13.i5.10
Feng
Zhang
Division of Plastic Surgery, Microsurgery Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
William C.
Lineaweaver
Division of Plastic Surgery. The University of Mississippi Medical Center, 2500, North State Street, Jackson, MS 39216-4505
Minimally Invasive Surgical Management of Ureteropelvic Junction Obstruction: Laparoscopic and Robot-Assisted Laparoscopic Pyeloplasty
18
10.1615/JLongTermEffMedImplants.v13.i5.20
Ravi
Munver
The James Buchanan Brady Foundation, Department of Urology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA
Joseph J.
Del Pizzo
The James Buchanan Brady Foundation, Department of Urology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA
R. Ernest
Sosa
The James Buchanan Brady Foundation, Department of Urology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA
Dix Phillip
Poppas
Chief, Pediatric Urology; Richard Rodgers Family; Assoc. Prof Urology, Pediatrics, Plastic&Reconstructive Surg.; Director, Lab. for Minimally Invasive Urologic Surgery, Childrens Hospital of New York; Presbyterian Weill Medical College of Cornell University, Ithaca, NY, USA
Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by an intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options, with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy and robot-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. These techniques offer substantial benefits to patients by reducing morbidity, hastening postoperative recovery, and improving cosmetic outcome. During the last decade, laparoscopic pyeloplasty has garnered much interest. However, because of the technically challenging nature of this procedure, it is performed only at select medical centers by surgeons with advanced laparoscopic training. The recent introduction of robotics to the field of minimally invasive surgery may facilitate this procedure and allow for more widespread implementation by surgeons of varying skill levels. This review is limited primarily to the treatment of congenital or acquired UPJ obstruction via laparoscopic and robot-assisted laparoscopic pyeloplasty. Herein, we report the early results, ongoing evolution, and potential future role for these novel surgical procedures.
Surgical Tissue Adhesives: New Additions to the Surgical Armamentarium
4
10.1615/JLongTermEffMedImplants.v13.i5.30
William D.
Spotnitz
Division of Thoracic and Cardiovascular Surgery, University of Florida; Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
Experience Improves Successful Use of Fibrin Sealant in Total Knee Arthroplasty: Implications for Surgical Education
10
10.1615/JLongTermEffMedImplants.v13.i5.40
Gwo-Jaw
Wang
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
Charles A.
Goldthwaite, Jr.
Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
Sandra G.
Burks
Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
William D.
Spotnitz
Division of Thoracic and Cardiovascular Surgery, University of Florida; Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
This study evaluating fibrin sealant application in total knee arthroplasty (TKA) found significant differences in the decline in adjusted hemoglobin loss at 48 hours postoperatively in the treatment group (FS) relative to the control group (C) when the groups were segregated into early and late subgroups. The decline between the late C, 3.53 ± 0.22 g/dL, and the late FS, 3.01 ± 0.20 g/dL, was 0.52 g/dL (p = 0.04). The decline between the early C, 3.51 ± 0.21 g/dL, and the early FS, 3.25 ± 0.22 g/dL, was 0.26 g/dL (p = 0.34). This study demonstrates the importance of experience and education in successful application of tissue adhesives.
Fibrin Sealant Reduces Perioperative Blood Loss in Total Hip Replacement
14
10.1615/JLongTermEffMedImplants.v13.i5.50
Gwo-Jaw
Wang
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
Charles A.
Goldthwaite, Jr.
Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
Sandra G.
Burks
Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
Ross
Crawford
Department of Biomedical Engineering, University of Technology, Queensland, Australia
William D.
Spotnitz
Division of Thoracic and Cardiovascular Surgery, University of Florida; Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia, USA
Patients (n = 81) undergoing total hip replacement (THR) were randomized to receive either standard of care plus fibrin sealant (FS) (10 mL total) or standard of care alone to evaluate the efficacy of FS for reducing blood loss in THR. Considering the 81 intent-to-treat patients, adjusted perioperative blood loss was reduced significantly in the FS group, by 197 mL [95% CI: 45 mL, 319 mL] or 23.5% [95% CI: 5.4%, 38.1%] (p = 0.014). When protocol violators were eliminated, leaving 73 patients, the adjusted FS group perioperative bleeding was reduced by 221 mL [95% CI: 63 mL, 351 mL] or 27.1% [95% CI: 7.6%, 42.5%] (p = 0.0098).
Presentation of Gamma-Irradiated-in-Air Polyethylene Wear in the Form of a Synovial Cyst
5
10.1615/JLongTermEffMedImplants.v13.i5.60
Bryan T.
Edwards
Medical College of Georgia, Department of Surgery, Division of Orthopaedics, Augusta, Georgia, USA
Patrick B.
Leach
Medical College of Georgia, Department of Surgery, Division of Orthopaedics, Augusta, Georgia, USA
R. Scott
Corpe
Section of Orthopaedic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia 30912-4030, USA
Robert D.
Zura
Assistant Professor of Orthopaedic Surgery, Duke University Medical Center, Division of Orthopaedic Surgery, Box 3389, Durham, NC 27710, USA
Timothy R.
Young
Naval Research Laboratory, Washington DC 20375-5344, USA
The increased wear of polyethylene sterilized with gamma irradiation in air has well been documented in the total knee arthroplasty literature. Our case report describes a patient with a well-functioning total knee replacement presenting with wear debris synovitis in the form of a large synovial cyst. We discuss this patient’s preoperative evaluation, intra-operative findings, and postoperative outcome after synovectomy and polyethylene exchange. We also review the current literature on appropriate polyethylene sterilization methods.
Blunt Thoracic Aortic Injury: Old Problem and New Technology
10
10.1615/JLongTermEffMedImplants.v13.i5.70
L.D.
Britt
Chairman, Brickhouse Professor of Surgery, Department of General Surgery, Eastern Virginia Medical School, Hofheimer Hall, 825 Fairfax Ave., Norfolk, VA 235001, USA
The lethal nature of transmural aortic injuries has remained constant; however, both the diagnostic and therapeutic interventional options have improved. Although aortography is still the "gold standard" against which all other diagnostic modalities are measured, contrast-enhanced spiral thoracic computed tomography has emerged as the diagnostic study that could potentially supplant aortography. The advent of the fast spiral computed tomography scanners offer several advantages, including being less affected by patient motion and volumeaveraging artifacts than the earlier generation CT scanners. The operative has broadened from primary repair and interposition prosthetic graft placement (with possible use of shunt or roller vs. centrifugal bypass) to the potential widespread use of endovascular stents. The Eastern Virginia Medical School (EVMS) experience during the first 10-year period (see table below) highlights the majority of patients undergoing interposition prosthetic graft placement. There was no use of shunts during this period. At the midpoint of the second 10-year period (1997-2007), the method of repair is exclusively interposition graft placement. The role of endovascular stent insertion in the management of these injuries is currently being debated.
EVMS experience: Primary repaire 23%
Graft 77%
Mode of management: Crossclamp 14%
Bypass 86%
Robotic Surgery: An Update
8
10.1615/JLongTermEffMedImplants.v13.i5.80
Scott E.
Langenburg
Assistant Professor of Pediatric Surgery; Director of Trauma; Director, Computer-Assisted Robotic-Enhanced Surgery, Childrens Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201, USA
Colin G.
Knight
Maxine and Stuart Frankel Foundation Computer-Assisted Robot Enhanced Surgery, Children’s Hospital of Michigan, Detroit, Michigan, USA; Children’s Research Center of Michigan; and Wayne State University School of Medicine
Michael D.
Klein
Maxine and Stuart Frankel Foundation Computer-Assisted Robot Enhanced Surgery, Children’s Hospital of Michigan, Detroit, Michigan, USA; Children’s Research Center of Michigan; and Wayne State University School of Medicine
Minimally invasive surgery techniques have revolutionized surgery. Robotic surgery may be the next revolution in surgical technology. Robotics coupled with minimally invasive surgery and microscopic surgery provides the potential to do more complex and more precise tasks. Robotic surgery offers tremor filtration, motion scaling, indexed movements, additional degrees of freedom, and improved ergonomics. We explore robotic history, the present surgical technology, the current clinical cases and research, and the future of robotics. We will look specifically at the birth and progress of our own problem.