Surgical technology international最新文献

In Canada, emergency departments (ED) have 15.1 million unscheduled visits every year; this has been suggested to indicate that patients rely on ED to address the gaps experienced by 6.5 million Canadians who lack a primary care provider. When this large number of visits is coupled with a predicted shortage of 100,000 nurses in Canada by 2030, ED can be expected to face resource limitations, which highlights the importance of triage systems as a source of immediate support. Technology that incorporates innovative analytical methods, automation of routine, and efficient processing can be leveraged to enhance patient outcomes, streamline clinical processes, and improve the overall quality and efficiency of healthcare delivery. This paper aims to highlight how the Triage-Bot, a proposed AI system, can assist ED nurses when triaging patients. The Triage-Bot system is based on the Canadian Triage and Acuity Scale (CTAS), which currently serves as a standardized and highly effective tool for prioritizing patient care in emergency departments across the country. Pre-set and open-ended questions are asked using voice and video, allowing patients to describe their health concerns and conditions. Triage-Bot automatically measures the following vital signs: heart rate (HR), heart rate variability (HRV), oxygen saturation (SpO2), respiratory rate (RR), blood pressure (BP), blood glucose (BG), and stress. The system uses artificial intelligence models, particularly those with a deep learning approach that simultaneously analyzes both the user's facial expression and voice tone. Implementation: A systematic review addressed the implications of AI in nursing and concluded that it could contribute to patient care by providing personalized instructions and/or remotely monitoring patients. The Triage-Bot system can be implemented in healthcare facilities, such as emergency department waiting rooms. The information it collects can then be added to a patient's health records to support nurses in assessing the severity of each patient's condition. Limitations: If the system is accessed without a nurse's guidance, it is imperative that the user receives information regarding when to visit a healthcare provider or ED. Continuous improvements in Triage-Bot's accessibility for patients with varying abilities are required to ensure that the system remains user-friendly during times of illness. The voice and text interaction can also be influenced by a user's understanding of language, culture, and age-related factors.

The advent of robotic bronchoscopy coupled with electromagnetic navigation bronchoscopy (EMN) and shape-sensing technology have increased diagnostic yields for peripheral pulmonary nodules compared to traditional bronchoscopy. Yet, diagnostic yields from these bronchoscopic platforms still fall short of where they should be. This shortfall is in large part due to a lack of advanced imaging during peripheral bronchoscopy and computed tomography (CT)-to-body divergence (CTBD). Digital lung tomosynthesis (DLT) is an advanced imaging modality that helps overcome CTBD during bronchoscopic biopsies of lung nodules. DLT is a quasi-3D imaging technique, which reconstructs tomographic images of the lung from a series of 2D fluoroscopic projection images. These images can be acquired either using a digital flat panel fluoroscopy machine or a fluoroscopy machine with a more traditional image-intensifier present in most standard bronchoscopy suites. This review aims to explain the mechanisms of both CTBD and DLT to help diagnose early-stage lung cancer more effectively.

Harry Reich, MD, FACOG, FRCOG, FACS is known worldwide as a pioneer in the field of laparoscopic surgery. He performed the first laparoscopic hysterectomy, the first pelvic lymphadenectomy for cancer, and the first excision of cul-de-sac endometriosis that included rectal resection. This article explores his life and contributions. The author knew Dr. Reich from medical conferences over many years and visited Dr. Reich in Pennsylvania to observe him in the operating room. For this article, the author spoke with Dr. Reich on nearly a nightly basis over a 13-month period in 2022 and 2023. Dr. Reich's descriptions were cross-referenced with his publications and those of his peers. The author also interviewed physicians who worked closely with Dr. Reich and reviewed the trial transcript of the February 1980 Nesbitt Memorial Hospital special ad hoc investigatory committee. The result is a comprehensive review spanning from Dr. Reich's early life to his ultimate recognition as one of the most significant innovators of advanced laparoscopic surgery. The author concluded that Dr. Reich's accomplishments are rooted in his command of pelvic anatomy, his lifelong interest in surgery and his willingness to challenge existing surgical dogma. By attending medical school in Ireland, Dr. Reich benefitted from the deep study of anatomy offered there. He also had a unique background of being a Harvard-trained gynecologic surgeon practicing in Wilkes-Barre, a small Pennsylvania community that trusted him because both his parents practiced medicine there before him. Dr. Reich favored conservative surgery rather than hysterectomy for endometriosis and patiently excised deep disease, offering relief to countless women, at times without compensation. He exhibited astonishing bravery and perseverance in the face of scathing criticism. Dr. Harry Reich's empathy for his patients and willingness to challenge the status quo were pivotal in improving the lives of many thousands of women and revolutionizing gynecologic surgery.

We describe the technique of total hip arthroplasty via a direct anterior approach using the Depuy Synthes (Raynham, MA) VELYS™ Hip Navigation system This technique allows one to accurately set the acetabular component position as well as recreate leg length and offset to meet the goals of hip reconstruction in a precise and efficient manner.

Introduction: The persistent shortage of donor hearts for transplantation has prompted exploration into Donation after Circulatory Death (DCD) as a promising avenue for organ procurement. This comprehensive review aims to examine recent advancements in DCD heart procurement and preservation techniques to address the critical need for donor organs and improve transplant outcomes.

Materials and methods: A systematic review was conducted to identify relevant studies and innovations related to DCD heart procurement and preservation. Electronic databases including PubMed, MEDLINE, and Google Scholar were searched using keywords such as "DCD heart donation," "organ preservation," and "transplantation." Studies with statistical analyses on transplant outcomes were included for further evaluation.

Results: A meta-analysis of DCD heart transplantation outcomes revealed a statistically significant increase in successful transplants utilizing hearts procured after circulatory death (p<0.05). Normothermic machine perfusion demonstrated a 20% reduction in ischemic time compared to traditional cold storage methods, leading to improved post-transplant cardiac function and reduced rates of primary graft dysfunction. These findings highlight the potential of DCD heart procurement and preservation techniques to address the critical shortage of donor hearts while enhancing transplant outcomes.

Conclusion: Recent innovations in DCD heart procurement and preservation techniques show promise in overcoming the challenges of donor organ scarcity and improving transplant success rates. Continued research and development in this field are essential to further optimize these techniques and meet the growing demand for donor hearts worldwide.

Cellular and matrix-like products come in many forms. Among them, powdered and micronized formulations have become increasingly available and popular owing to their unique properties and advantages. Powders have increased tissue contact which many believe can enhance granulation tissue formation, they fill irregular and deep cavities, and they can be used in concert with sheet-like products and skin grafts for improved healing. Despite their advantages, powdered products do have certain limitations that hinder their use, including poor insurance coverage and a lack of CPT coding for adequate reimbursement in an outpatient setting, making their use primarily limited to the operating room. Also, most published data on powdered products consists of smaller case studies and case series, with few reports evaluating the efficacy and utility of powdered formulations compared to their sheet-like progenitors. In this manuscript, we organize available powdered matrix products by type of substrate: xenograft, allograft, placental-based, and synthetic, and review the data in support of various products in specific wound types. This review of the supporting literature provides the current body of evidence on the utility of powdered matrices in wounds.

Ultrasound-guided minimally invasive thermoablative (MIT) therapies are a therapeutic option for selected patients with large, hypoenhancing, benign thyroid nodules that cause compression disorders or aesthetic discomfort. MIT, which does not require general anaesthesia, causes thermal necrosis of the treated nodule, which is reduced in size by 50 % without functional consequences, and is indicated for patients who are not too young or in the presence of anaesthesia-related risk factors or recurrence following thyroidectomy or refusal of surgery. For the above indications, MIT complements surgery but does not replace it; it must always be performed in centres and by surgeons with proven technical skills and clinical experience. Subject to appropriate informed consent, the treatment is short-duration, well-tolerated by the patient, safe, and non-invasive. It does not require anaesthesia and complications are rare and transient. MIT, and in particular laser-based procedures (TAL), can also be effective and safe for the treatment of potentially destructible papillary microcarcinoma, as shown by the limited but sufficient literature, including the most recent guidelines, which consider it to be a therapeutic alternative that requires a better understanding of its efficacy and safety.

While total hip arthroplasty (THA) is an enormously successful treatment for patients with end-stage degenerative arthritis of the hip, and surgeons have optimized existing hip implants and techniques, dislocation and instability persist as a leading cause of failure. Given the tremendous success of reverse total shoulder arthroplasty in enhancing the stability of shoulder reconstruction by reversing the anatomic seating of the ball and socket components, one manufacturer (Hip Innovation Technology, LLC, Woodstock, Georgia) has developed a novel Reverse Hip Replacement System (Reverse HRS) to address the need for greater stability in reconstruction of the arthritic hip joint. Rather than the traditional anatomic components that replace the head of the femur with a spherical ball and the acetabulum with a socket with polyethylene liner mounted into the pelvis, the Reverse HRS features a cup with polyethylene liner attached to the femoral stem and a spherical metal head attached to a central trunnion inside of the porous-coated acetabular shell fixed into the pelvis. This design provides dramatically enhanced stability and improved range of motion. This article reviews relevant published literature, including results from a Canadian clinical trial and case reports from a multicenter American clinical trial monitored by the U.S. Food and Drug Administration. It also describes the components and surgical technique of reverse THA.

Artificial intelligence and technology have continued to evolve over recent decades, and their utility in hip and knee arthroplasty is growing with interest and enthusiasm. A multitude of technologies are available to assist surgeons in the intraoperative execution of hip and knee arthroplasty, ranging from robotics and augmented reality to artificial intelligence-powered fluoroscopy. The purpose of this review is to provide a framework for arthroplasty surgeons to understand the concept of artificial intelligence and the advancements in technologies that impact the perioperative care of patients undergoing hip and knee arthroplasty.

Introduction: Achieving excellent cosmetic monsplasty results consistently can be difficult. Undertreatment or overtreatment of the fatty ptotic mons pubis will yield suboptimal results. A stepwise tactical approach to the monsplasty eliminates these problems and produces excellent aesthetic results.

Materials and methods: The surgical management of monsplasty requires individualization and careful surgical planning. The authors' approach illustrating the steps and tactics to perform monsplasty is presented. Based on our experience with 1,200 cases, a comprehensive clinical classification of mons pubis ptosis with surgical guidelines for treatment was created.

Results: Over 1200 patients have undergone monsplasty using the authors' stepwise tactical approach to mons rejuvenation. No complications associated with the monsplasty occurred. Patient satisfaction with the monsplasty was very high.

Conclusion: In the authors' experience, the preoperative grading of the mons pubis ptosis and the use of guidelines produces consistently excellent aesthetic results. Monsplasty is associated with high aesthetic and functional patient satisfaction.