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Surgical Plan (surgical + plan)
Selected AbstractsIntraoperative Transesophageal Echocardiography in Valve Replacement SurgeryECHOCARDIOGRAPHY, Issue 8 2002Raphael Rosenhek M.D. Transesophageal echocardiography (TEE) is applied widely during heart valve replacement surgery. Intraoperative TEE (IOTEE) is used to formulate the surgical plan, assess cardiac function, and evaluate surgical outcome. This review describes the methodology of IOTEE, focusing on its role in valve replacement surgery. Specific aspects, such as its role in surgical decision making, selection of the prosthetic model and size, detection and quantification of paravalvular leaks, outflow tract obstruction, and acute prosthetic valve obstruction, are discussed. Furthermore, a description of the value of IOTEE in newer procedures, such as port access surgery, is presented. [source] Evaluating effectiveness of preoperative testing procedure: some notes on modelling strategies in multi-centre surveysJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2008Dario Gregori PhD Abstract Rationale, In technology assessment in health-related fields the construction of a model for interpreting the economic implications of the introduction of a technology is only a part of the problem. The most important part is often the formulation of a model that can be used for selecting patients to submit to the new cost-saving procedure or medical strategy. The model is usually complicated by the fact that data are often non-homogeneous with respect to some uncontrolled variables and are correlated. The most typical example is the so-called hospital effect in multi-centre studies. Aims and objectives, We show the implications derived by different choices in modelling strategies when evaluating the usefulness of preoperative chest radiography, an exam performed before surgery, usually with the aim to detect unsuspected abnormalities that could influence the anaesthetic management and/or surgical plan. Method, We analyze the data from a multi-centre study including more than 7000 patients. We use about 6000 patients to fit regression models using both a population averaged and a subject-specific approach. We explore the limitations of these models when used for predictive purposes using a validation set of more than 1000 patients. Results, We show the importance of taking into account the heterogeneity among observations and the correlation structure of the data and propose an approach for integrating a population-averaged and subject specific approach into a single modeling strategy. We find that the hospital represents an important variable causing heterogeneity that influences the probability of a useful POCR. Conclusions, We find that starting with a marginal model, evaluating the shrinkage effect and eventually move to a more detailed model for the heterogeneity is preferable. This kind of flexible approach seems to be more informative at various phases of the model-building strategy. [source] Portable duplex ultrasonography: A diagnostic and decision-making tool in reconstructive microsurgeryMICROSURGERY, Issue 5 2010Andreas Gravvanis M.D., FEBOPRAS, Ph.D. Unidirectional Doppler is a common diagnostic tool by the Reconstructive Microsurgeons; however, it may generate false signals and surely provides less imaging data as compared to duplex ultrasonography. We have reviewed the use of Portable Duplex Ultrasonography (PDU) in 16 patients who underwent complex soft-tissue/bone reconstruction, aiming to determine its role in the design and management of free tissue transfer. According to our data, there were modifications either of the surgical plan and/or of patient's management, based on PDU findings, in 10 out of 16 patients (62.5%). The use of ultrasound directed to subtle modifications in three patients (19%), but to significant changes of the surgical plan in four patients (25%). Also, the use of ultrasound improved significantly the postoperative management in three patients (19%). Thus, significant impact of PDU in patient's treatment was recorded in 44% of cases. Portable ultrasound represents generally available method for preoperative, intraoperative, and postoperative diagnosis and decision-making in free tissue transfer, hence could replace in the near future the unidirectional Doppler in the hands of Microsurgeons. © 2010 Wiley-Liss, Inc. Microsurgery 30:348,353, 2010. [source] Image-guided surgery of liver metastases by three-dimensional ultrasound-based optoelectronic navigationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2007S. Beller Background: Vessel-oriented surgery and tumour-free resection margins are essential for resection of liver metastases to preserve liver parenchyma and improve oncological outcome. Preoperative three-dimensional models reconstructed from imaging data could facilitate surgical planning with the use of navigation technology. Methods: Thirty-three patients with central and/or impalpable liver metastases were scheduled for navigated hepatic resection. Intraoperative three-dimensional ultrasonography and an infrared-based optical tracking system were used for data registration and image-guided surgery. Postoperative three-dimensional data were compared with the preoperative virtual surgical plan to assess the accuracy of navigation, and clinical results were compared with those of a matched control group of 32 patients. Results: Navigation was successful in 32 of 33 patients. Realization of the preoperative plan and R0 resection was achieved in 30 of these 32 patients. The median discrepancy between the planned and actual vascular dissection level was 6 (range 0,11) mm. There was a reduced rate of R1 resection in the navigated group compared with the control group (two versus four patients), and more parenchyma was preserved. Conclusion: Three-dimensional ultrasound-based optoelectronic navigation technology improves intraoperative orientation and enables parenchyma-preserving surgery with high precision. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | ||||||||||