Part Of Surgery Research Articles

Microscope integrated MHz optical coherence tomography system for neurosurgery: development and clinical in-vivo imaging.

Neurosurgical interventions on the brain are impeded by the requirement to keep damages to healthy tissue at a minimum. A new contrast channel enhancing the visual separation of malign tissue should be created. A commercially available surgical microscope was modified with adaptation optics adapting the MHz speed optical coherence tomography (OCT) imaging system developed in our group. This required the design of a scanner optics and beam delivery system overcoming constraints posed by the mechanical and optical parameters of the microscope. High quality volumetric OCT C-scans with dense sample spacing can be acquired in-vivo as part of surgical procedures within seconds and are immediately available for post-processing.

A pilot on intelligence fusion for anesthesia depth prediction during surgery using frontal cortex neural oscillations

Anesthetic agents are widely used for their hypnotic and sedative effects as part of surgical procedures, but despite their widespread use there continues to be suboptimal dosing of the anesthetic to the patients, which necessitates more effective means of monitoring the depth of anesthesia (DoA) as anesthetic agents are administered. Effective means towards DoA monitoring could improve the optimal dosing for each patient to reduce the incidence awareness under general anesthesia and post-operative cognitive dysfunction; as well as reduce the incidence of complications associated with overdosing, such as hypertension. This work presents a novel pilot case study on an ongoing research around more effective means of DoA prediction, where patient-specific models are designed using a combination of signal processing and machine learning alongside electroencephalography (EEG) signals acquired from the frontal cortex. This particular case study investigates the use of various intelligence sources, i.e., machine intelligence, representing unsupervised feature extraction from a convolutional neural network (CNN), and expert-based intelligence via handcrafted features for the prediction of the DoA. It was seen that the handcrafted features provided the highest prediction accuracy across the various patient data, due to the ability to ‘bake-in’ prior knowledge regarding the physics of the process into the feature extraction process. The highest prediction accuracy was seen to be 86.5 ± 9.9 % for the LDA classification model upon pre-processing with the Linear Series Decomposition Learner (LSDL) algorithm. The fusion of both intelligence sources also provided an equivalent prediction accuracy similar to that of the hand-crafted features only.

Single Port Radical Hysterectomy with Total Mesometrial Resection (TMMR) as Part of Surgical Procedures in Cases of Cervical Cancer

Single Port Radical Hysterectomy with Total Mesometrial Resection (TMMR) as Part of Surgical Procedures in Cases of Cervical Cancer

HoG feature based detection of tissue deformations in ultrasound data.

The fast development of imaging techniques during last decades makes it possible to introduce intra-operative visualization as the integral part of surgical procedures. Therefore, the automated analysis of intra-operative ultrasound images is appreciated. The image processing, registration and visualization techniques help in better understanding and locate the operated region. To meet these needs, the paper presents an advanced algorithm for automated detection of tissue deformations caused by a biopsy needle. For this, feature set of Histogram of Gradients (HoG) is introduced. The extracted feature vectors are then used in image cell clustering step resulting in tissue deformation as well as biopsy needle detection. The applied there Kernelized Weighted C-Means clustering technique enables robust and accurate needle detection proven by sensitivity and specificity values at levels of 0.846 and 0.99, respectively.

Trans-Femoral Amputation in Elderly Dysvascular Patients

The clinical and functional results of traditional techniques for trans-femoral amputation are often poor. The ISPO consensus conference on amputation surgery in 1990 at Glasgow recommended myodesis as an important integral part of surgical procedure and should be carried out as much as possible. Muscle stabilization provides a stable functional amputation stump. This improves the prosthetic management and walking ability. A technique of myodesis for trans-femoral amputation has been developed in Dundee, especially for elderly dysvascular patients. The functional and clinical results of this technique were studied in 33 patients, who underwent the surgical procedure. Data regarding patient demographics, postoperative morbidity, mortality and functional status were obtained from a prospectively recorded pro forma. Fourteen patients out of 33, who were operated using this technique, were fitted with artificial limbs. Of these, 11 (78.5%) were still using the prosthesis at a mean follow-up of 40 months. There was 100% primary wound healing. Two patients underwent further revision surgery for delayed stump problems. Good clinical and functional results were obtained using this technique. It is particularly suited for the elderly dysvascular patients, whose stumps are shorter and bone quality poor. The low rate of stump problems and consequent revision surgery enables a more comfortable stump for non-prosthetic users.

Risk factors for scoliosis in children treated for neuroblastoma

To determine the risk factors for scoliosis in children treated for neuroblastoma. From 1957 to 1997, 58 children with neuroblastoma were treated at 1 institution and have survived a minimum of 5 years. There were 35 boys and 23 girls with a median age of 6 months (range, 2 weeks to 15 years) at initial diagnosis. Primary site was located in the adrenal gland in 25 (43.1%), abdominal /non-adrenal in 16 (27.6%), thoracic in 12 (20.7%), cervical in 3 (5.3%) and pelvic region in 2 (3.5%). The International Neuroblastoma Staging System (INSS) stage was Stage 1 in 10 (17.2%), Stage 2A in 7 (12.1%), Stage 2B in 5 (8.6%), Stage 3 in 22 (37.9%), Stage 4 in 4 (6.9%) and Stage 4S in 10 (17.2%) children. Thirty-three (56.9%) received chemotherapy while 5 (8.6%) had a laminectomy as part of surgical procedure. Twenty-seven (46.6%) received radiotherapy (RT). Beam energy was 1.25 MV in 11 (41%), 250 KV in 10 (37%), 4 MV in 4 (15%) and 6 MV photons in 1 patient. One patient received 300cGy in 1 fraction total skin RT using 6 MeV electrons. For the remaining patients, fraction size was 100 cGy in 6 (22%), 150–180 cGy in 11 (41%), 200 cGy in 4 (15%) and 250–300 cGy in 3. Three patients had total body irradiation at 333cGy for 3 fractions. For all children who received RT, median total dose was 2000 cGy (range, 300–3900 cGy). Patients who had RT had plain films of the irradiated area every 1 to 2 years until at least the age of puberty. Median follow-up was 10 years (range 5–46 years). The overall 5-, 10- and 15-year scoliosis-free rates were 87.6%, 79.0% and 76.0% respectively. Twelve (21%) developed scoliosis at a median time of 51 months (range, 8–137 months) from initial diagnosis. The degree of scoliosis was mild (less than or equal to 20 degrees) in 8 (67%). Four patients had scoliosis ranging from 30 to 66 degrees; three of these patients required orthopedic intervention, while 1 had an underlying Duchenne muscular dystrophy which manifested itself 8 years after diagnosis. Median time to scoliosis was 23 months in children who had a laminectomy (range 8–54 months). On multivariate analysis, both history of laminectomy (p = .0005) and use of RT (p = .0284) were found to be risk factors for development of scoliosis. Gender, age at diagnosis, INSS stage, primary site and use of chemotherapy were not found to be significant. Both fraction size and beam energy were also not significant, but increasing total RT dose was found to be significant on logistic regression analysis (p = 0.0017).The 15-year scoliosis-free rates were 20% for children who had a laminectomy and 81.3% for those who did not have laminectomy. The 15-year scoliosis-free rates for children treated with RT doses 0 cGy, 1–1750 cGy, 1751–2300 cGy and greater than 2300 cGy were 91.7%, 87.5%, 51.4% and 44.4% respectively (p = .0039,log-rank). Treatment-related factors, namely laminectomy and radiotherapy, were found to increase the risk of scoliosis in patients with neuroblastoma. Children who had a laminectomy were more likely to manifest scoliosis earlier. Increasing RT dose was found to impact adversely on the development of scoliosis.

Is routine appendectomy beneficial in the management of ovarian cancer?

A retrospective analysis of 136 patients with ovarian carcinoma subjected to appendectomy as a part of surgical procedure was carried out to assess the importance of appendectomy in patients with ovarian cancer. Of the 136 patients studied, 94 had epithelial and 38 had non-epithelial type of primary ovarian carcinoma. In the remaining 4 patients, the primary operation was performed with an intraoperative diagnosis of ovarian carcinoma but the final pathological examination revealed appendiceal carcinoma metastatic to ovaries. The overall appendiceal involvement in the study group with primary ovarian cancer was found to be 32.5% ( 43 132 ). This figure was 15.7% and 39.3% for non-epithelial and epithelial tumors, respectively. Involvement of the appendix ranged from 8.8% for patients with stage I disease to 46.0% for patients with stage III–IV disease. Four of the appendices found to be inflamed during the surgical explorations were later reported as acute appendicitis. The frequent occurrence of metastatic disease in the appendix in patients with ovarian cancer suggests routine appendectomy is appropriate for staging early cases and for contributing to maximal cytoreduction in advanced cases.