Surgical Pen Research Articles

Minimally Invasive Resection of a Large Subcutaneous Lipoma: The 2.5-cm (1-inch) Method.

Minimally Invasive Resection of a Large Subcutaneous Lipoma: The 2.5-cm (1-inch) Method.

Are Antiperspirants Safe? Shedding Light on the Distribution of Aluminum Compounds in Sweat Glands.

The safety of antiperspirants has been a subject of intense debate, with conflicting perspectives and research findings. This study aimed to contribute to the discussion by investigating the distribution of aluminum chloride (AlCl3), a common ingredient in antiperspirants, within the sweat glands. We enrolled a total of 10 patients seeking surgery for bromhidrosis in our study. Before surgery, we instructed the study participants to apply a specially formulated AlCl3 staining antiperspirant to their underarms using a surgical pen with ink that resists easy removal. We excised the apocrine glands, fragmented them finely, and examined them microscopically. We did not detect any stained aluminum compounds. These results are consistent with previous research, which suggests that aluminum compounds do not enter the apocrine glands. Consequently, concerns regarding the potential absorption of aluminum into the human body appear to be unfounded, particularly regarding cancer risks such as breast cancer.

Keratinized mucosa changes around one-stage implants: A prospective case series.

The need of an adequate band of keratinized tissue (KT) to maintain periodontal health around teeth as well as around implants has been a debated topic over many years but still no conclusions have been drawn. This prospective case series evaluates the changes undergone by the keratinized mucosa (KM) and the soft tissue volume around non-submerged implants before the prosthetic rehabilitation. A total of 40 patients were included. The primary outcome was to analyze the width of the KM at both buccal and lingual aspects compared to the pre-existing KT in the edentulous ridge only in mandibular (pre)molar area. The mucogingival line was marked with a surgical pen and an intra-oral scanner was used to take the impression of the implant area the day of the surgery (T0, baseline) and before the crown placement (T1, 3months). Buccal soft tissue volume was measured at 1, 3, and 5 mm apical to the healing abutment position and a comparison between T0 and T1 was performed. Student t-test was used according to the distribution of the data (Shapiro-Wilk). The mean KT width at baseline was 4.54 ± 1.31 mm at buccal side and 5.04 ± 1.88 mm at lingual side. After 3months, the mean KM values were 3.15 ± 1.03 mm and 3.72 ± 1.56 mm at the buccal and lingual aspects, respectively. The differences, 30.6% of KM reduction buccally and 26.1% of reduction lingually, were statistically significant for both sides. Within the limitations of this investigation, it was observed that the KM width from the baseline to the 3months follow up presented a significant dimensional change in both the buccal and lingual aspects, whereas buccal soft tissue volume showed an increase between baseline and follow up.

Anesthesiologic management of pregnant women with SARS-COV-2 infection undergoing cesarean delivery

Background: Pregnant women are usually more susceptible to infection due to typical physiological and mechanical changes, such as increased heart rate, stroke volume and pulmonary residual capacity. The aim of this study was to evaluate an innovative anesthesiologic opioid-free management protocol in symptomatic pregnant women, with COVID-19 and with oxygen therapy, undergoing cesarean delivery with spinal anesthesia. Methods: With the patient in the sitting position, spinal anesthesia was performed at the L1–L2 level. Vertebral level has been identified starting from the sacrum, we counted the laminae in the caudal-to-cephalad direction, which was then marked with a surgical pen. The technique was performed in asepsis, in the subarachnoid space after vision of clear Cephalo-Spinal Fluid (CSF) in the spinal needle 27 Gauge, without letting out the CSF, bupivacaine 0.5% 10 mg, dexmedetomidine 10 μg and dexamethasone 4 mg was injected. Results: During the study period, 40 pregnant women with one or more symptoms and supplemental oxygen (FiO2 35–40%) who underwent cesarean delivery were included in the study. All pregnant women had pain visual analog scale (VAS) ≤3, and no pregnant women required rescue dose. Adverse effects, such as nausea, vomiting, shivering, or pruritus were not recorded in any case. After a mean of 2.5 hours from the spinal anesthesia, all the included women had a complete motility of the lower limbs and were able to mobilize independently within 12 hours after delivery. Mean time to first flatus was about 8 hours after delivery. Conclusions: Pregnant women in COVID-19 can safely receive intrathecal dexamethasone and dexmedetomidine during planned cesarean delivery.

Robotic laser osteotomy through penscriptive structured light visual servoing.

Planning osteotomies is a task that surgeons do as part of standard surgical workflow. This task, however, becomes more difficult and less intuitive when a robot is tasked with performing the osteotomy. In this study, we aim to provide a new method for surgeons to allow for highly intuitive trajectory planning, similar to the way an attending surgeon would instruct a junior. Planning an osteotomy, especially during a craniotomy, is performed intraoperatively using a sterile surgical pen or pencil directly on the exposed bone surface. This paper presents a new method for generating osteotomy trajectories for a multi-DOF robotic manipulator using the same method and relaying the penscribed cut path to the manipulator as a three-dimensional trajectory. The penscribed cut path is acquired using structured light imaging, and detection, segmentation, optimization and orientation generation of the Cartesian trajectory are done autonomously after minimal user input. A 7-DOF manipulator (KUKA IIWA) is able to follow fully penscribed trajectories with sub-millimeter accuracy in the target plane and perpendicular to it (0.46mm and 0.36mm absolute mean error, respectively). The robot is able to precisely follow cut paths drawn by the surgeon directly onto the exposed boney surface of the skull. We demonstrate through this study that current surgical workflow does not have to be drastically modified to introduce robotic technology in the operating room. We show that it is possible to guide a robot to perform an osteotomy in much the same way a senior surgeon would show a trainee by using a simple surgical pen or pencil.

The Effect of Pain Reduction during Headframe Fixation for Stereotactic Radiosurgery by the Preceded Local Anesthesia under the Needle Cap Guidance.

BackgroundGamma knife radiosurgery (GKRS) has become a major alternative in the neurosurgical field. However, many patients complained of considerable discomfort during the fixation of rigid headframe. This study investigated whether our modified procedure could reduce fixation-related pain.MethodsSixty-six patients who underwent GKRS were enrolled in this study. Thirty-one patients (Group A) underwent the conventional subcutaneous infiltration technique, and 35 patients (Group B) did the modified procedure. In group A, the headframe was held in position by an assistant, and local anesthetics were injected subcutaneously using a 23-gauge spinal needle at pinning sites. Subsequently, pins were applied according to measurements based on spinal needle depth. In group B, with the frame held in position by an assistant, pin sites were marked with a surgical pen under the guidance of needle cap placed on the pin holes. The head frame was then removed, and local anesthetics were injected subcutaneously and periosteally at each marked pin site using a 26-gauge needle. The headframe was then repositioned 5 minutes after local infiltration, and pins were applied according to measurements based on spinal needle depth. To evaluate pain severity during procedures, visual analogue scale (VAS) scores were recorded during local infiltration and frame placement with pins. The pain scores of the two groups were analyzed statistically.ResultsGroup B had a significantly lower VAS score during frame placement than group A (7.26 vs. 3.61; p<0.001), and mean VAS score at local infiltration was also significantly lower in group B (4.74 vs. 3.74; p=0.008).ConclusionPatients in group B experienced significantly less pain than those in group A during pin placement. Pre-fixation time advanced local anesthesia might reduce pain during stereotactic procedures, and the use of a 26-gauge needle appeared in less pain during local infiltration.

Intraoperative monitoring of torsion to prevent vertical deviations during augmented vertical rectus transposition surgery

Total transposition of the superior and inferior rectus muscle laterally, with augmentation sutures, may be complicated by induction of an undesirable vertical deviation. Induced vertical misalignment may be associated with changes in torsion. We have developed a simple method to monitor intraoperative torsion that may reduce the incidence of vertical deviations. We reviewed consecutive cases of total abducens palsy or esotropic Duane syndrome treated with augmented lateral transposition of the superior and inferior rectus muscles, where the 12 o'clock and 6 o'clock intraoperative positions were initially marked with a dot at the limbus using a surgical pen. The location of the marks was monitored during tying of the augmentation sutures; changes in torsion were monitored intraoperatively. Records of 9 cases of augmented vertical rectus transposition were reviewed. On the basis of intraoperative assessment of torsion, by observing the position of preplaced limbal dots, the inferior rectus augmentation suture was tied less tightly than the superior rectus suture, leaving a gap of 1 to 3 mm between the inferior and lateral rectus muscles in 8 of 9 cases. The augmentation suture was totally removed in 1 case. After these intraoperative adjustments, there was no induced intraoperative torsion, whereas further tightening of the inferior suture induced extorsion. Six weeks postoperatively, 8 of 9 patients did not experience a symptomatic vertical deviation. When performing augmented transposition procedures, intraoperative monitoring of torsion may reduce the incidence of inadvertent vertical deviations and torsion. This technique may also be useful in other cases where correction or avoidance of torsion is needed.

Delineating Capillary Malformations in the Operating Suite Using White Eyeliner Pencil

Delineating the extent of capillary malformations in the operating suite can be challenging because of a variety of physiologic modifiers, including vasodilatation induced by anesthesia, reactive erythema, and filtering of colors with protective laser eyewear. The use of traditional surgical pens to mark the treatment field has limitations; we have found the use of a white eyeliner pencil to delineate lesions a contemporary technique that assists in identifying the target tissue intraoperatively.

Surgical Pearl: A unique surgical marker

Skin marking pens play an important role in the routine activities of a dermatological surgeon. Because preoperative infiltration of local anesthetic may alter the topography of the skin, surgical pens are used to guide excisions and to help identify anatomic sites, such as the lacrimal punctum.1 Historically, multiple unique markers have been reported, including ballpoint pens, 2 hypodermic needles,3 a wooden stick or wooden penholder with a felt tip,4 a stick with a cotton swab, an artist’s brush, and an autoclavable, refillable steel pen with an adjustable sized tip.

Use of Q-switched alexandrite laser (755 nm, 100 nsec) for removal of traumatic tattoo of different origins.

Q-switched laser systems have been used for removal of tattoo-related carbon, graphite, and other particles. We assessed elimination of traumatic tattoos of different origin with Q-switched alexandrite laser in nine patients. Fluence threshold was determined and a spot test was made. Q-switched alexandrite laser, with a fluence range 4.5-8.0 J/cm(2) (mean, 7.16 +/- 1.18), was used at 4-5-week intervals. Total treatment ranged from 3-12 sessions (mean, 6.1 +/- 3.6 sessions). Double-pulse technique was used in black/black-bluish areas, but single-shot was applied to slate-gray pigment. More than 95% lightening was achieved in five patients after 5.2 +/- 2.3 sessions, and >75% lightening in six subjects after 6.1 +/- 3.1 sessions of treatment. Blacktop, surgical pen, and gravel tattoos presented a better response than gunpowder/fireworks tattoos (>95% vs. 68.7 +/- 23.9% clearance), or tattoos of unknown origin (>95% vs. 62.5 +/- 53% clearance). Epidermal splattering and pinpoint bleeding were observed in one case. No pigmentary alteration or scarring was seen. The Q-switched alexandrite laser is a useful system for removal of traumatic tattoos of diverse origin. The best response (>95% clearance) was achieved in blacktop, surgical pen, and gravel tattoos, although an acceptable degree of lightening may be obtained in tattoos due to gunpowder or fireworks.

Use of Q‐switched alexandrite laser (755 nm, 100 nsec) for removal of traumatic tattoo of different origins

Background and Objectives Q-switched laser systems have been used for removal of tattoo-related carbon, graphite, and other particles. We assessed elimination of traumatic tattoos of different origin with Q-switched alexandrite laser in nine patients. Study Design/Materials and Methods Fluence threshold was determined and a spot test was made. Q-switched alexandrite laser, with a fluence range 4.5–8.0 J/cm2 (mean, 7.16 ± 1.18), was used at 4–5-week intervals. Total treatment ranged from 3–12 sessions (mean, 6.1 ± 3.6 sessions). Double-pulse technique was used in black/black-bluish areas, but single-shot was applied to slate-gray pigment. Results More than 95% lightening was achieved in five patients after 5.2 ± 2.3 sessions, and >75% lightening in six subjects after 6.1 ± 3.1 sessions of treatment. Blacktop, surgical pen, and gravel tattoos presented a better response than gunpowder/fireworks tattoos (>95% vs. 68.7 ± 23.9% clearance), or tattoos of unknown origin (>95% vs. 62.5 ± 53% clearance). Epidermal splattering and pinpoint bleeding were observed in one case. No pigmentary alteration or scarring was seen. Conclusion The Q-switched alexandrite laser is a useful system for removal of traumatic tattoos of diverse origin. The best response (>95% clearance) was achieved in blacktop, surgical pen, and gravel tattoos, although an acceptable degree of lightening may be obtained in tattoos due to gunpowder or fireworks. Lasers Surg. Med. 25:445–450, 1999. © 1999 Wiley-Liss, Inc.