Single Surgeon's Technique Research Articles

Surgical Technique for Below-knee Amputation with Concurrent Targeted Muscle Reinnervation.

Summary:Targeted muscle reinnervation (TMR) is beneficial for decreasing pain following below-knee amputation (BKA). While most current literature describes the principles behind primary TMR, they provide few principles key to the amputation, as the BKA is usually performed by another surgeon. When the BKA and TMR are performed by the same surgeon, it can be performed through the same surgical access as needed for both procedures. The purpose of this article is to describe our anatomically based BKA technique in the setting of planned primary TMR as performed by 3, single, peripheral nerve plastic surgeons at 2 institutions. Advantages of the single-surgeon technique include efficiency in dissection, preservation of donor nerve length, limited proximal dissection, early identification of recipient motor nerves for coaptation, ability to stimulate these while still under tourniquet, and decreased tourniquet and operative time. This technique is quick, reliable, and reproducible to help promote widespread adoption of TMR at the time of BKA.

Solo surgeon strabismus surgery technique

AbstractBackgroundStrabismus surgery is frequently undertaken solo without surgical assistants, requiring alternative methods for accurate muscle isolation and placement. We aim to describe a novel single surgeon technique during recti muscle surgery in the management of horizontal strabismus.MethodsAfter isolating the recti muscle on a hook, the muscle is secured with a double armed 6‐0 Vicryl (Ethicon) on a spatulated needle at the point of insertion. A partial thickness bite is taken at the muscle belly followed by two full thickness locking bites at the superior and inferior poles of the muscle. For recessions, the 6‐0 suture is placed behind the blades of the Cook speculum which acts to keep sutures away from the area and provides some traction opposite to that from the Moody forceps. This allows good visualisation and allows the surgeon to mark the suture placement site. Tucking the suture behind the Cook speculum also helps with resection but there is less of a traction element required here.ResultsThis technique has been proven to be effective in allowing the surgeon to operate without an assistant. There have been fewer lists cancellations due to absences and lack of an assistant. Furthermore postoperative results have been comparable to those operated with an assistant.ConclusionThe advantages of this technique are its ease of execution without having to rely on extra instrumentation. It allows the solo surgeon to operate without having to depend on an assistant thereby increasing efficiency and reducing waiting list times. It is also a very handy tip and easily taught to trainees.ReferenceWinter TW, Olson RJ et al. Resident and Fellow Participation in Strabismus Surgery: Effect of level of training and number of assistants on operative time and cost. (2014) Ophthalmology, 121(3), 797‐801.

Changes and optimization of operator model in laparoscopic anastomic hepatectomy

Laparoscopic anatomical resection (LAR) is a highly-demanding and high risky procedure. Traditional single-surgeon technique appears to be frustrating when dealing with intro-operative emergency and ensuring the safety of complicated LAR. The authors′ department has applied two-surgeon technique when performing LAR since 2014. In complicated cases of LAR, two skillful surgeons cooperate to perform surgeries. The two surgeons stand at each side of the patient and switch their duties as the surgeon or the assistant during the operation. Experience of the authors’ department shows that compared with single-surgeon technique, two-surgeon technique can help better deal with intro-operative accidental events such as hemorrhage and guarantee the safety of LAR, as well as enhance the efficiency and quality of procedures. Two-surgeon technique benefits team building and training young laparoscopic liver surgeons, and help them pass the learning curve more safely and quickly. Key words: Anatomical liver resection; Single-surgeon technique; Two-surgeon technique; Laparoscopy

Scleral-sutured intraocular lenses: Single-surgeon technique for suture-preloaded intraocular lens insertion through a small-incision corneal wound

For scleral intraocular lens (IOL) fixation, suture-loaded IOLs have traditionally been folded in half with a forceps and delivered intraocularly through 3.5 to 4.0mm corneal wounds. We describe a technique in which a suture-loaded scleral IOL is inserted through a small-incision corneal wound using 2 widely available ocular surgery tools; that is, a C or D cartridge and a Bowman nasolacrimal duct probe. This technique is easy to replicate and can be performed without an assisting surgeon.

Two-Surgeon Technique for laproscopic anatomical hepatectomy

Laproscopic anatomical hepatectomy (LAH) is a highly-demanding procedure. Single-surgeon technique, which is widely adopted in open hepatectomy, can no longer meet the demands of LAH very well. Our department is one of the first hepatobiliary surgery centers which routinely applied Two-Surgeon Technique when performing LAH. Two-Surgeon Technique means having two skillful and experienced surgeons cooperate LAH, the two surgeons exchange their duty of Surgeon or Assistant as needed during the operation. Two-surgeon Technique can better guarantee the safety of LAH, as well as enhance the efficiency and quality of procedures. Key words: Laparoscopy; Hepatectomy; Hepatic veins

Bilateral mastectomies: can a co-surgeon technique offer improvements over the single-surgeon method?

Bilateral mastectomy (BM) is traditionally performed using a single-surgeon (SS) technique (SST); a co-surgeon (CS) technique (CST), where each attending surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We sought to compare the CST and SST for BM with respect to operative times and complications. Patients undergoing BM without reconstruction at our institution between 2005 and 2015 were identified using operative caselogs and stratified into CS- and SS-cohorts. Operative time (OT; incision to closure) was calculated. Patient age, cancer presence/stage, hormone receptor/BRCA status, breast weight, axillary procedure, and 30-day complications were extracted. Differences in OT, complications, and demographics between cohorts were assessed with t tests and Chi-square tests. A multivariate linear regression model was fit to identify factors independently associated with OT. Overall, 109 BM cases were identified (CS, n = 58 [53.2%]; SS, n = 51 [46.8%]). Average duration was significantly shorter for the CST by 33min (21.6% reduction; CS: 120min vs. SS: 153min, p < 0.001), with no difference in complication rates (p = 0.65). Demographic characteristics did not differ between cohorts except for total breast weight (TBW) (CS: 1878g vs. SS: 1452g, p < 0.05). Adjusting for TBW, CST resulted in a 27.8% reduction in OT (44-min savings, p < 0.001) compared to SST. The CST significantly reduces OT for BM procedures compared to the SST without increasing complication rates. While time-savings was < 50% and may not be ideal for every patient, the CST offers an alternative BM approach potentially best-suited for large TBW patients and those undergoing axillary procedures.

Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years.

Abdominoplasty patients are frequently candidates for breast rejuvenation as well. Transabdominal breast augmentation permits insertion of breast implants through the abdominoplasty incision. This combined procedure is preferentially performed in an outpatient setting under monitored anesthesia care and nerve blocks. This study was a 14-year retrospective review of a single surgeon's technique and outcomes using transabdominal breast augmentation through a low transverse abdominoplasty incision in select patients requesting simultaneous abdominoplasty and bilateral breast augmentation. Patients had minimal ptosis, smoking cessation a minimum of 4 weeks before surgery and indefinitely thereafter, and a lack of superior abdominal or significant breast surgery. The study's 114 patients had a mean follow-up of 19.2 months. The procedure was performed under monitored anesthesia care with intercostal nerve blocks for most patients [n = 107 (93.9 percent)] and general anesthesia [n = 7 (6.1 percent)] for a few. Seventy-nine patients [n = 74 (64.9 percent)] underwent additional procedures, with most (n = 48) undergoing suction-assisted lipectomy. Many patients underwent multiple procedures. Most complications occurred predictably along the central distal abdominoplasty flap and were minor (small wound breakdown, seroma, and mild skin infection). Major complications [n = 8 (7.0 percent)] included two patients with implant malposition requiring revision and one patient with a Baker grade III capsule; notably, this patient was a half-pack-per-day smoker with a body mass index of 27 kg/m. Transabdominal breast augmentation is a safe, reliable procedure in the appropriately selected, healthy patient and may be used in minimally to moderately ptotic patients who request concurrent breast augmentation and abdominoplasty. Morbidity compares favorably to reported abdominoplasty series in the appropriately selected patient. Therapeutic, IV.

Thoracoscopic surgery for esophageal atresia.

This review centers on the thoracoscopic management of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). The first thoracoscopic repair of EA was performed by Rothenberg and Lobe in Berlin in 1999 just prior to an IPEG meeting. Since that time, the largest report describing the use of thoracoscopy for EA/TEF repair came in 2005 with a multi-national, multi-institutional retrospective review from six institutions around the world. The outcomes reported were quite good and very comparable to large series of open operations that had been previously reported. This review will describe a single surgeon's technique for thoracoscopic repair of EA/TEF. In addition, further controversies regarding the usefulness of preoperative bronchoscopy, ligation of the distal TEF, and type of suture used for the esophageal anastomosis will also be discussed. Finally, there is a discussion on the advantages and disadvantages of the thoracoscopic approach.

Anterior cervical osteotomy for fixed cervical deformities.

Description of surgical technique with case series. To describe the surgical management of fixed cervical deformities using an anterior osteotomy of the cervical spine. Although posteriorly based osteotomies of the cervical spine have been described in the past, there are no reports of the surgical technique for performing an anterior osteotomy of the cervical spine for fixed cervical deformities. Description of a single surgeon's technique for performing an anterior cervical osteotomy and his experience in performing this technique from 2000 to 2010 in a consecutive series of patients. Demographics, operative details, and clinical/radiographical outcomes were collected. The cohort was separated into 2 groups. Group 1 had anterior osteotomy only with or without posterior instrumentation whereas group 2 had anterior osteotomy and Smith-Petersen osteotomies with posterior instrumentation. A total of 38 patients (group 1 = 17, group 2 = 21) underwent an anterior osteotomy in the study period with an average follow-up of 3.4 years (range, 1.0-6.3 yr). All but 7 cases were revision cases. Group 1 had shorter length of surgery and less estimated blood loss than group 2 (length of surgery 220 vs. 313 min, P < 0.01; estimated blood loss 189 vs. 294 mL, P = 0.02).The mean angular correction achieved in group 1 was less than that of group 2, although not statistically significant (23° vs. 33°, P = 0.15). There was less mean translational correction achieved in group 1 compared with group 2 (1.3 vs. 3.7 cm, P = 0.03). Both groups had improvements in the neck disability index with surgery and were similar between groups (20 vs. 19.7, P = 0.78). There were no neurological complications or intraoperative neuromonitoring changes in either group. The use of an anterior osteotomy in the cervical spine is safe and effective for the correction of fixed deformities of the cervical spine. When necessary, Smith-Petersen osteotomies can add to the angular and translational correction to achieve a satisfying outcome for patients. 4.

Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases

The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke's cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke's cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92% concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73%) for GH-secreting, 12/12 (100%) for ACTH-secreting, and 8/17 (47%) for prolactin-secreting tumors. Post-operative complications included transient (11%) and permanent (1.4%) diabetes insipidus, hyponatremia (13%), and new anterior pituitary hormonal deficits (1.4%). CSF leak occurred in 42 cases (15%), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10% of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes appear to be better than those reported in microscope-based series, regardless of a one or two surgeon technique.

Pedicle Subtraction Osteotomy in the Cervical Spine

Description of surgical technique with review of literature. To describe the surgical management of cervical spine deformity, using pedicle subtraction osteotomy. Previous articles have primarily described Smith-Petersen osteotomies and Simmons' modifications to correct fixed cervical deformity. Those were typically performed with the patient awake and sedated in a seated position and without the use of spinal instrumentation. Description of a single surgeon's technique for performing pedicle subtraction osteotomy to treat fixed cervical deformity. The use of pedicle subtraction osteotomy in the cervical spine is a safe and effective procedure when performed by experienced surgeons and can result in a satisfying outcome for both the patient and the surgeon.

An Evidence-Based Review of a Single Surgeon's Experience With Endoscopic Carpal Tunnel Release

Although introduced more than 20 years ago, endoscopic carpal tunnel release (ECTR) continues to generate debate and controversy among surgeons. This review examines a single surgeon's technique for ECTR over the past 13 years to better understand the effects of a surgeon's experience on outcomes. A retrospective review was performed on a case series of 129 patients ages 25 to 89 years old who underwent an ECTR at Duke University. Ninety-six percent of patients reported improvement in nerve symptoms. There were no nerve complications in the series. The billed cost of ECTR at Duke University was 9% less than standard open release and the average return to work by report by patients was 3 weeks. Previous recommendations against ECTR have focused on increased complication rates and cost, with no reported differences in long-term clinical outcomes. The results demonstrate increased success and lower complication rates for this series of patients. This may indicate a significant correlation between a surgeon's expertise and outcomes for ECTR.

Minimally Invasive Plate Osteosynthesis of Distal Radius Fractures Using a Pronator Sparing Approach

Volar locking plates for fractures of the distal radius are a common option of care in many centers. Currently, these plates are placed through a standard approach, such as the flexor carpi radialis interval. However, in our opinion, the use of conventional plate application techniques is associated with more soft tissue dissection than is necessary for these new plates. This may contribute to postoperative pain and also to scarring, which may impede the range of motion. To avoid this, dorsal plates have been developed that can be inserted percutaneously. Historically, dorsal plating of the distal radius has been associated with increased morbidity relative to volar plates due to soft tissue depth. This article discusses a single surgeon's technique for insertion of volar locking plates through minimal incisions with sparing of the soft tissues.

Reply: Laparoscopic Live Donor Nephrectomy: The Single Surgeon Technique

Journal of the American College of Surgeons: September 2003 - Volume 197 - Issue 3 - p 521 doi: 10.1016/S1072-7515(03)00594-5