Microsurgery of the Larynx Larynx

Total Page:16

File Type:pdf, Size:1020Kb

Microsurgery of the Larynx Larynx Microsurgery of the larynx Larynx LLOYD A. SEYFRIED, D.O., FOCO Detroit, Michigan This article describes a method of the Yankauer (1910) and the suspension microsurgery that facilitates precise, frames of Killian, Lynch, or Siefert, were delicate endolaryngeal surgery with monocular tubes. The addition of telescopes to monocular laryngoscopes, did not afford depth minimal trauma while viewing the perception or allow the use or manipulation of larynx with binocular vision and instruments while viewing. Lewys 1 depth per- three-dimensional selected magnification. ception device provided binocular viewing, but The technique utilizes a simple lacked magnification. modification of the operating microscope A method of microsurgery of the larynx was described by Scalco, Shipman, and Tabb 2 in already in use by the otolaryngologist. 1960, using the Zeiss operating microscope The draped surgical microscope is with a 300 mm. objective lens and the Lynch fitted with a 375 or 400 mm. objective suspension laryngoscope. The authors were lens. The eyepiece housing on the pleased with the brilliant three-dimensional left is fitted with a viewing tube so that image, but felt the need of better designed the resident can view the entire instruments, since standard laryngeal instru- ments gave the sensation of "working with procedure. If photographs are to be crowbars." taken, a camera can be attached to the Kleinsasser3 in 1963 developed a binocular eyepiece housing on the right. The laryngoscope for use with the Zeiss operating technique described here can be microscope, fitted with a 400 mm. objective employed in cases of mucosal and lens. Fine, delicate instruments were devel- oped, produced by the Reiner Company. Klein- submucosal changes in the pharynx and sasser4 in 1965 described microsurgical proce- larynx, small or moderate sized lesions dures for vocal cord stripping for Reinkes of the vocal cords, ventricles, edema, laryngeal polyps, leukoplakia, pachy- or ventricular bands, and endolaryngeal derma, singers nodes, and carcinoma in situ. surgical procedures. Among more extensive procedures performed were endolaryngeal resection of the vocal cord, arytenoidectomy, and the treatment of adhesions and stenosis. Jako5 in 1964 developed a binocular fiber op- tic laryngoscope for microdiagnosis and micro- surgery of the larynx, for use with the Zeiss Microsurgery of the larynx is a method of operating microscope. The Jako laryngoscope performing precise delicate endolaryngeal sur- (produced by George P. Pilling Company) is gical procedures with minimal trauma while attached to the Lewy 6 gear-driven suspension viewing the larynx with binocular vision and arm supported on a Mayo stand, placed a few selective magnification. It is, in fact, the ap- inches above the patients chest. Jako also de- plication of the surgical principles of middle veloped a microsurgical instrumentarium for ear microsurgery to the larynx. endolaryngeal surgery well adapted to the re- Most laryngoscopes of the past, except for quirements of a precise technique. These in- 246/86 struments are produced by the Stumer Com- passes a No. 26 cuffed endotracheal tube by pany. way of the mouth between the vocal cords in- General anesthesia is a practical necessity to the trachea. in microsurgery of the larynx to provide the The tube has a built-in inflating channel and surgeon with prolonged time for examination is designed for nasotracheal introduction. The and performance of precise microsurgical pro- added length of this tube places the anesthe- cedures. An endotracheal technique employing siologists connector and valves far enough a 26-gauge cuffed endotracheal tube with gen- from the mouth that they will not interfere eral anesthesia was described by Priest and with the introduction of the laryngoscope or Wesolowski7 in 1959. This method has been the manipulation of instruments. The cuff is found to provide adequately ventilation for inflated and the pilot tube clamped. The small most patients requiring this procedure, in- tube does not interfere with visualization since cluding many patients with pre-existing chron- it lies completely in the interarytenoid space ic pulmonary disease, chronic bronchitis, bron- in the posterior part of the larynx. If it is nec- chiectasis, and emphysema. The recent re- essary to look at the posterior portion of the lease of Innovar provides a safe method of larynx, the tube can be elevated by the laryn- general anesthesia adaptable to microlaryngo- goscope tip to cause it to lie anteriorly. The scopy by an experienced anesthesiologist. cuffed tube prevents bleeding into the trachea and fogging of lenses. Technique When Innovar is used, the anesthetic gas is My own experiences with microlaryngoscopy changed to nitrous oxide and oxygen. In select- and microendolaryngeal surgery have followed ed cases the endotracheal tube may be omit- rather closely the methods of Kleinsasser and ted completely. of Jako. I would anticipate many changes and The Jako laryngoscope illuminated with refinements in the future, as occurred in the twin fiber optic light bundles is introduced in- development of microsurgery of the middle to the pharynx. The instrument is held in the ear. Consequently, a high degree of adaptabil- left hand, the tip engages the epiglottis, which ity to these expected developments should be is lifted, and the laryngoscope is advanced to maintained. expose the vocal cords. The teeth are protect- The technique I employ is as follows: The ed with a rubber gump. In the edentulous pa- patients larynx is sprayed topically with Ce- tient, a pad of gauze moistened in saline or tacaine aerosol spray and the larynx is view- Tissu-Sol, protects the alveolar ridge. A stur- ed with a mirror by the resident, who drops 2 dy Mayo stand is positioned a few inches cc. of 4% Xylocaine between the vocal cords above the patients chest and firmly tightened with a laryngeal syringe. The patient then lies to sustain the pressure exerted by the Lewy on his back on the surgical table and the an- frame. With the right hand, the Lewy frame esthesiologist starts an intravenous infusion of is fastened to the handle of the laryngoscope 5% dextrose, and succinylcholine is added to and the support arm of the frame lowered to obtain muscle relaxation. Fluothane anesthe- contact the Mayo stand; the gear of the frame sia is then induced. When the patient is suffi- is then tightened sufficiently to expose the ciently relaxed, the anesthesiologist exposes larynx, including the anterior commissure, to the larynx with a McIntosh laryngoscope and full view (Fig. 1). Journal AOA/vol. 68, November 1968 247/87 Fig. 1. Jako laryngoscope with Lewy suspension arm in use with Zeiss microscope arranged for horizontal viewing. mirror, properly adjusted for angulation. With small fine suction tips, the surface can be kept clean and bloodless (Fig. 2). Palpation of vocal cords with the probe or suction tip will detect induration and submucosal changes, found in carcinoma in situ and early carcinoma. Changes in the vascular pattern are also noted. Kleinsasser8 has classified vascular patterns found in hyperkeratosis and precancerous and cancerous lesions. Normal capillary branching Fig. 2. Stiimer microsurgical laryngeal instruments. is broken in precancerous and carcinomat- ous laryngeal mucosa. Capillaries thus take on wormlike and U-shaped patterns, instead of At this point both hands are free. The the twig-branch appearance of the normal draped surgical microscope, adjusted for hori- capillary tree. zontal viewing and fitted with a 375 or 400 The brilliant three-dimensional visualiza- mm. objective lens, is wheeled into position so tion with which one can see the tiniest lesion that the operator, seated at a comfortable is remarkable. Removal is accomplished with height, can obtain a full, three-dimensional, small knives, forceps, scissors, and snares de- unobstructed view of the larynx. Straight signed for this procedure. With them, one can viewing tubes are necessary to obtain a com- work as precisely and accurately as in middle fortable viewing and operating position. The ear surgery. Only tissue that is clearly patho- eyepiece housing on the left is fitted with a logic is removed. This can be accomplished House-Urban viewing tube so that the resi- with greatly decreased trauma and with a dent will be able to view the entire procedure. subsequent reduced period of healing (Figs. The right side of the microscope is unob- 3-8). structed to permit passage, manipulation, and withdrawal of instruments. If photographs are Indications to be taken, the House-Urban Robot camera The following are indications for microlaryn- is attached to the right eyepiece housing and goscopy and endolaryngeal microsurgery as will not interfere greatly with the passage or presently developed: manipulation of instruments. Pilling Com- 1.Mucosal and submucosal changes in the pany makes a photographic attachment devel- pharynx and larynx. Kleinsasser° states that oped by Jako for photography of the larynx, the laryngomicroscope is as valuable to the if the microscope has not been adapted for laryngologist as the culdoscope is to the gyne- House-Urban equipment. cologist in the differential diagnosis of muco- The magnification for diagnosis and surgery sal changes, especially the early diagnosis of is selected; usually this is from 16x to 25x. carcinoma. The ventricles are inspected by opening them 2. Small or moderate sized lesions of the with a small blunt hook to retract the ven- vocal cords, ventricles, or ventricular bands; tricular bands. The undersurface of the vocal these include polyps, nodules, cysts, leukopla- cords can be seen with the aid of a small Jako kia, hyperkeratosis, and carcinoma in situ. 248/88 Fig. 3 (left). Polyp of right vocal cord (X16). Fig. 4 (right). Immediate postoperative view; polyp removed (X16). 3. Endolaryngeal surgical procedures such as Teflon paste injection of the vocal cord for flaccid adductor paralysis; cordectomy or ary- tenoidectomy for bilateral abductor paralysis. Contraindications Fig. 5 (left). Large irregular vocal nodules (X10). Microlaryngoscopy and endolaryngeal micro- Fig.
Recommended publications
  • Microsurgery: Free Tissue Transfer and Replantation
    MICROSURGERY: FREE TISSUE TRANSFER AND REPLANTATION John R Griffin MD and James F Thornton MD HISTORY In 1964 Nakayama and associates15 reported In the late 1890s and early 1900s surgeons began what is most likely the first clinical series of free- approximating blood vessels, both in laboratory ani- tissue microsurgical transfers. The authors brought mals and human patients, without the aid of magni- vascularized intestinal segments to the neck for cer- fication.1,2 In 1902 Alexis Carrel3 described the vical esophageal reconstruction in 21 patients. The technique of triangulation for blood vessel anasto- intestinal segments were attached by direct microvas- mosis and advocated end-to-side anastomosis for cular anastomoses in vessels 3–4mm diam. Sixteen blood vessels of disparate size. Nylen4 first used a patients had a functional esophagus on follow-up of monocular operating microscope for human ear- at least 1y. drum surgery in 1921. Soon after, his chief, Two separate articles in the mid-1960s described Holmgren, used a stereoscopic microscope for the successful experimental replantation of rabbit otolaryngologic procedures.5 ears and rhesus monkey digits.16,17 Komatsu and 18 In 1960 Jacobson and coworkers,6 working with Tamai used a surgical microscope to do the first laboratory animals, reported microsurgical anasto- successful replantation of a completely amputated moses with 100% patency in carotid arteries as digit in 1968. That same year Krizek and associ- 19 small as 1.4mm diameter. In 1965 Jacobson7 was ates reported the first successful series of experi- able to suture vessels 1mm diam with 100% patency mental free-flap transfers in a dog model.
    [Show full text]
  • Robotics in Neurosurgery
    The American Journal of Surgery 188 (Suppl to October 2004) 68S–75S Robotics in neurosurgery Paul B. McBeth, M.A.Sc., Deon F. Louw, M.D., Peter R. Rizun, B.A.Sc., Garnette R. Sutherland, M.D.* The Seaman Family MR Research Center, Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, 1403 29th Street N.W., Calgary, Alberta T2N 2T9, Canada Abstract Technological developments in imaging guidance, intraoperative imaging, and microscopy have pushed neurosurgeons to the limits of their dexterity and stamina. The introduction of robotically assisted surgery has provided surgeons with improved ergonomics and enhanced visualization, dexterity, and haptic capabilities. This article provides a historical perspective on neurosurgical robots, including image- guided stereotactic and microsurgery systems. The future of robot-assisted neurosurgery, including the use of surgical simulation tools and methods to evaluate surgeon performance, is discussed. Heavier-than-air flying machines are impossible. for holding and manipulating biopsy cannulae. Although the —Lord Kelvin (William Thomson), robot served only as a holder/guide, the potential value of Australian Institute of Physics, 1895 robotic systems in surgery was evident. In 1991, Drake and coworkers [3] reported the use of a PUMA robot as a Neurosurgeons, constrained by their anthropomorphic de- retraction device in the surgical management of thalamic sign, may have reached the limits of their dexterity and astrocytomas. Despite their novel application, both systems stamina. The combination of magnification of the operative lacked the proper safety features needed for widespread field and tool miniaturization has overwhelmed the spatial acceptance into neurosurgery. Beginning in 1987, Benabid resolution of the adult human hand.
    [Show full text]
  • A Brief History of Otorhinolaryngolgy Otology, Laryngology And
    Rev Bras Otorrinolaringol 2007;73(5):693-703. ARTIGO DE REVISÃO REVIEW ARTICLE Breve história da A brief history of otorrinolaringologia: otologia, otorhinolaryngolgy: otology, laringologia e rinologia laryngology and rhinology João Flávio Nogueira Júnior 1, Diego Rodrigo 2 3 Palavras-chave: história da medicina, otorrinolaringologia. Hermann , Ronaldo dos Reis Américo , Iulo Keywords: history of medicine, otorhinolaryngology. Sérgio Barauna Filho 4, Aldo Eden Cassol Stamm 5, Shirley Shizuo Nagata Pignatari 6 Resumo / Summary O nariz, a garganta e o ouvido intrigam a humanidade Ears, nose and throat have intrigued humanity since desde os períodos mais remotos. Tratamentos laringológicos, immemorial times. Treatments for the larynx, the nose rinológicos e otológicos, além de cirurgias, já eram pratica- and the ear and also surgeries were practiced by Greek, dos por médicos gregos, hindus e bizantinos. No século XX Hindu and Byzantine doctors. In the 20th century clinical inovações clínicas e cirúrgicas foram incorporadas graças às and surgical innovations were incorporated, thanks to novas técnicas anestésicas, aos antibióticos, à radiologia e às new anesthesia techniques, antibiotics, radiology and new novas tecnologias. Objetivo e Método: Mostrar a evolução technologies. Aim and method: show the evolution of desta ciência ao longo dos tempos, reconhecendo figuras this science throughout the times, recognizing important importantes da otologia, rinologia e laringologia por revisão persons in otology, rhinology and laryngology. Results and em literatura. Resultado e Conclusão: O conhecimento conclusion: Understanding the evolutions in clinical and das evoluções em anatomia, fisiologia, tratamentos clínicos surgical anatomy, physiology, treatment modalities, and the e cirúrgicos, além das personalidades que conduziram a personalities that lead to these advances is of great importance estes avanços é de grande importância para que a ciência for the evolution of medical science.
    [Show full text]
  • 1 PAUL ANDREW STONE, D.P.M., M.B.A. Castle Rock Foot & Ankle
    PAUL ANDREW STONE, D.P.M., M.B.A. Castle Rock Foot & Ankle Care 2352 Meadows Blvd, #270, Castle Rock, CO 80109 EDUCATION ILLINOIS COLLEGE OF PODIATRIC MEDICINE - Chicago, Illinois Doctor of Podiatric Medicine, Cum Laude (1982) Durlacher Honor Society, Vice President (1980) Illinois Podiatric Medical Students Association, President (1981) Illinois Podiatric Medical Students Association, Secretary (1980) THE UNIVERSITY OF PHOENIX - Phoenix, Arizona Master of Business Administration (1992) THE UNIVERSITY OF MICHIGAN - Ann Arbor, Michigan Bachelor of Science in Microbiology/Immunology, Cum Laude (1978) RESIDENCY HIGHLANDS CENTER HOSPITAL - Denver, Colorado Surgical Residency Program in Advanced Foot and Ankle Surgery (1982-1984) FELLOWSHIPS 1 AMERICAN COLLEGE OF FOOT ORTHOPEDISTS Fellow - Certificate #318 (1991) AMERICAN COLLEGE OF FOOT AND ANKLE SURGEONS Fellow - Certificate #86-327 (1986) ST. ELIZABETH HOSPITAL - Ravensburg, Germany Karl Stuhmer, M.D., Chief - Department of Orthopedics and Traumatology A-O International Orthopedic Traumatology (1988) LICENSES AND CERTIFICATIONS STATE OF COLORADO PODIATRIC MEDICAL LICENSE Number #00374 AMERICAN BOARD OF PODIATRIC SURGERY Diplomate, Certificate #1555 (1986) AMERICAN BOARD OF PODIATRIC ORTHOPEDICS Diplomate, Certificate #625 (1991) AMERICAN BOARD OF FOOT AND ANKLE ORTHOPEDICS AND MEDICINE Diplomate, Certificate #0813 AMERICAN BOARD OF PODIATRIC ORTHOPEDICS AND PRIMARY PODIATRIC MEDICINE 2 Diplomate, Certificate #1433 (2000) AMERICAN ACADEMY OF PAIN MANAGEMENT Diplomate, Certificate #2358
    [Show full text]
  • Microsurgery
    Fundamentals of Microsurgery David A. Wilkie, DVM, MS, Diplomate ACVO Professor Department Chair The Ohio State University [email protected] Microsurgery Ophthalmic Vascular Urogenital Neurologic Microsurgery Definition Surgery utilizing magnification and small, handheld instruments and suture to correct defects in small &/or delicate tissues 16th CENTURY Ouch! To do a job….you need the right tools Microsurgery Differs from traditional surgery in: Surgeon position Magnification Specialized instrumentation Suture and needle size Dr. Dyce Surgeon Position Surgical Position Seated Specialized chairs with armrests Arms resting on armrest Essential for fine motor control Microsurgery Surgical Position Seated Specialized chairs with armrests Arms resting on table or armrest Essential for fine motor control Able to adjust height Height is adjustable Elbows and wrists are locked Magnification - There are choices… Fundamentals of Microsurgery Magnification – purpose: provide an improved view of the tissues of concern Will vary by tissue of interest allow a comfortable working distance for the surgeon Back straight, arms at 90 degrees facilitate adjustment of the interpupillary distance to suit the surgeon permit a wide field of view Microsurgery Differs from traditional surgery in: Specialized instrumentation Surgeon position Magnification Type & size of suture Human Hair 9-0 MonofilamentVicryl Fundamentals of Microsurgery Rules of microsurgery are meant as a foundation to guide the beginning ophthalmic surgeon Once understood, rules can occasionally be molded and adapted to suit the surgeon and the individual patient The surgeon must however always re-visit the basic microsurgical rules and principles when a new or unfamiliar technique or procedure is to be performed Fundamentals of Microsurgery Surgeons must have a goal and a plan to achieve the goal, but must also be adaptable and familiar with more than one technique so that obstacles encountered during the surgical procedure may be overcome.
    [Show full text]
  • Modern Endodontic Surgery Concepts and Practice: a Review Syngcuk Kim, DDS, Phd, MD(Hon), and Samuel Kratchman, DMD
    Review Article Modern Endodontic Surgery Concepts and Practice: A Review Syngcuk Kim, DDS, PhD, MD(hon), and Samuel Kratchman, DMD Abstract Endodontic surgery has now evolved into endodontic he classic view that endodontic surgery is a last resort is based on past experience microsurgery. By using state-of-the-art equipment, Twith accompanying unsuitable surgical instruments, inadequate vision, frequent instruments and materials that match biological con- postoperative complications, and failures that often resulted in extraction of the tooth. cepts with clinical practice, we believe that micro- As a result, the surgical approach to endodontic therapy, or surgical endodontics, was surgical approaches produce predictable outcomes in taught with minimum enthusiasm at dental schools and was practiced by very few in the healing of lesions of endodontic origin. In this private practices. Stated simply, endodontic surgery was not considered to be important review we attempted to provide the most current within the endodontist’s domain. concepts, techniques, instruments and materials with Fortunately, this changed when the microscope, microinstruments, ultrasonic the aim of demonstrating how far we have come. Our tips, and more biologically acceptable root-end filling materials were introduced in the ultimate goal is to assertively teach the future gen- last decade (Fig. 1). The concurrent development of better techniques has resulted in eration of graduate students and also train our col- greater understanding of the apical anatomy, greater treatment success and a more leagues to incorporate these techniques and con- favorable patient response. These developments marked the beginning of the endodon- cepts into everyday practice. (J Endod 2006;32: tic microsurgery era that began in the 1990s.
    [Show full text]
  • Duke Plastic and Reconstructive Surgery 1934 Randolph Jones, Jr
    A History of DUKE PLASTIC AND RECONSTRUCTIVE SURGERY 1934 RANDOLPH JONES, JR. Prior to the formal development of plastic surgery as a subspecialty, plastic and reconstructive procedures at Duke University were performed by both Dr. Deryl Hart and Dr. Clarence Gardner. In 1934, Dr. Randolph Jones was appointed as the first chief of the division of Plastic Surgery after completing his general surgery residency at Duke. He served in this position until he was tragically gunned down by a paranoid schizophrenic patient in 1941 who believed he had been mistreated. A total of six bullets entered the surgeon’s body before the assailant was overpowered by several other physicians. Dr. Jones’ widow, Virginia Jones, who Excellence in remarried Duke’s football coach Wallace Wade, donated money for LEADERSHIP Duke Plastic Surgery Research in the name of her late husband in Every chief of Plastic Surgery has 1986 under the stipulation that contributed in a unique way to the donation remain anonymous building what is now recognized until her death. as a top academic, clinical, and educational program. 1944 1975 KENNETH PICKRELL NICHOLAS GEORGIADE Dr. Kenneth Pickrell was recruited In 1975, Dr. Nicholas Georgiade to join the staff at Duke in 1944 earned the position of chief of and assumed the role of head of the division. Dr. Georgiade held the Division of Plastic Surgery. degrees in both dentistry and Dr. Pickrell completed a surgery medicine and completed his residency at Johns Hopkins, which residency at Duke in 1954. included training in all specialties of surgery. He developed an interest During his tenure at Duke, in plastic surgery and trained under Dr.
    [Show full text]
  • Helsinki Microneurosurgery Basics and Tricks
    t of Neu en r os tm u r r a g p e e r y D U n d i n v Est. 1932 la er n si Fi ty of Helsinki Lehecka | Laakso Hernesniemi t of Neu en r os tm u r r a g p e e r y D U n d i n v Est. 1932 la er n si Fi ty of Helsinki t of Neu en r os tm u r r a g p e e r y D U n d i n v Est. 1932 la er n si Fi ty of Helsinki Department of Neurosurgery at Helsinki University, Finland, led by its chairman Juha Hernesniemi, has become one of the most frequently visited neurosurgical units in the Helsinki Microneurosurgery world. Every year hundreds of neurosurgeons come to Helsinki to observe and learn t of Neu en r os microneurosuergery from Professor Juha Hernesniemi and his team. tm u r r a g Basics and Tricks p e e r y D In this book we want to share the Helsinki experience on conceptual thinking behind U n d i n v Est. 1932 la er n what we consider modern microneurosurgery. We want to present an up-to-date si Fi ty of Helsinki manual of basic microneurosurgical principles and techniques in a cook book fashion. Martin Lehecka, Aki Laakso It is our experience that usually the small details determine whether a particular and Juha Hernesniemi surgery is going to be successful or not. To operate in a simple, clean, and fast way while preserving normal anatomy has become our principle in Helsinki.
    [Show full text]
  • Curriculum Vitae
    CURRICULUM VITAE Harry John Visser, D.P.M. Diplomate, American Board of Foot and Ankle Surgery Diplomate, American Board of Foot and Ankle Medicine Fellow, American College of Foot and Ankle Surgeons EDUCATION: High School: Cardinal High School Middlefield, Ohio Graduated June, 1970 College: Kent State University Geagua Branch Chardon, Ohio Sept. 1970-June 1972 Hiram College Hiram, Ohio Sept. 1972-June 1974 Degree: B.A. Chemistry Magna Cum Laude PROFESSIONAL EDUCATION: Ohio College of Podiatric Medicine Cleveland, Ohio Graduated May 1978 Degree: Doctor of Podiatric Medicine RESIDENCY TRAINING: Lindell Hospital St. Louis, Missouri Three year residency in Foot and Ankle Medicine and Surgery July 1, 1978-June 30, 1981 Chief Resident: July 1, 1980 - June 30, 1981 RESIDENCY DIRECTOR RESIDENTS TRAINED: Mineral Area Regional Medical Center Farmington, Missouri PMS 24: 45 1984 - 2007 PMS 35: 8 2008 - 2013 PMSR-RRA: 4 2014 - 2015 Total: 57 Residents Residency closed 2015 SSM DePaul Health Center St. Louis, Missouri PMSR-RRA: 27 2012 - Present Total: 32 Residents Overall: 89 2 PROFESSIONAL ORGANIZATIONS PROFESSIONAL SCHOOL: 1. American Institute of Chemists 1974-1975 2. American Chemical Society 3. Alpha Gamma Kappa Professional Fraternity 1974-1978 a) Rush Chairman 1975 b) President 1976 - 1977 4. Inter-Fraternity Council Inter-Fraternity President 1976 - 1977 5. Intramural Softball Team OCPM, Captain 1974 6. Student Member, American Podiatry Association 1974-1978 7. PI DELTA Honor Fraternity 1977-1978 President 1978 8. Bruce Landry Memorial Award for Outstanding Senior Member Alpha Gamma Kappa Fraternity 1978 PROFESSIONAL PRIVATE PRACTICE 1. Member, American Podiatric Medical Association 1978-Present 2. Member, Missouri Podiatry Association 1978-Present 3.
    [Show full text]
  • The History of Microsurgery
    European Journal of Orthopaedic Surgery & Traumatology (2019) 29:247–254 https://doi.org/10.1007/s00590-019-02378-7 GENERAL REVIEW • GENERAL ORTHOPAEDICS - MICROSURGERY The history of microsurgery Andreas F. Mavrogenis1 · Konstantinos Markatos2 · Theodosis Saranteas3 · Ioannis Ignatiadis4 · Sarantis Spyridonos4 · Marko Bumbasirevic5 · Alexandru Valentin Georgescu6 · Alexandros Beris7 · Panayotis N. Soucacos1 Received: 2 January 2019 / Accepted: 4 January 2019 / Published online: 10 January 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Microsurgery is a term used to describe the surgical techniques that require an operating microscope and the necessary spe- cialized instrumentation, the three “Ms” of Microsurgery (microscope, microinstruments and microsutures). Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively smaller blood vessels and nerves that have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Cur- rently, with obtained experience, microsurgical techniques are used by several surgical specialties such as general surgery, ophthalmology, orthopaedics, gynecology, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery and more. This article highlights the most important innovations and milestones in the history of microsurgery through the ages that allowed the inauguration and establishment of microsurgical techniques in the feld of surgery. Keywords Microsurgery · Orthopaedics · Plastics Introduction Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively Microsurgery is a term used to describe the surgical tech- smaller blood vessels and nerves (typically 1 mm in diam- niques that require an operating microscope and the neces- eter) that have allowed transfer of tissue from one part of sary specialized instrumentation (the three “Ms” of Micro- the body to another and re-attachment of severed parts.
    [Show full text]
  • Loupes-Only Microsurgery Is a Safe Alternative to the Operating Microscope: an Analysis of 1,649 Consecutive Free Flap Breast Reconstructions
    Original Article Loupes-Only Microsurgery is a Safe Alternative to the Operating Microscope: An Analysis of 1,649 Consecutive Free Flap Breast Reconstructions Christopher J. Pannucci, MD, MS1 Marten N. Basta, BS2 Stephen J. Kovach, MD2 Suhail K. Kanchwala, MD2 Liza C. Wu, MD2 Joseph M. Serletti, MD2 1 Division of Plastic Surgery, University of Utah, Salt Lake City, Utah Address for correspondence Christopher J. Pannucci, MD, MS, Division 2 Division of Plastic Surgery, University of Pennsylvania, of Plastic Surgery, University of Utah, Salt Lake City, UT Philadelphia, Pennsylvania (e-mail: [email protected]). J Reconstr Microsurg Abstract Background Loupes-only microsurgery challenges the paradigm that free flap surgery requires an operating microscope. We describe our loupes-only microsurgery experi- ence with an emphasis on rates of intraoperative anastomotic revision and total flap loss. Methods We identified all patients having breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) or deep inferior epigastric perforator (DIEP) flaps over 7 years. We examined rates of intraoperative anastomotic revision and total flap loss as markers of technical quality. For one high-volume surgeon who started loupes-only microsurgery while at our institution, we examined rates of intraoperative anastomotic revision and total flap loss rates over time to evaluate for a learning curve. Results We performed 1,649 ms-TRAM or DIEP flaps in 1,063 patients. For 1,649 flaps, the rate of artery anastomotic revision was 2.2% (36 arteries) and venous anastomotic revision was 2.2% (37 veins). Any microvascular revision was performed in 3.5% (58 flaps).
    [Show full text]
  • Laser-Assisted Surgery of the Upper Aero-Digestive Tract
    Eur Arch Otorhinolaryngol (2017) 274:3723–3727 DOI 10.1007/s00405-017-4708-3 LARYNGOLOGY Laser‑assisted surgery of the upper aero‑digestive tract: a clarifcation of nomenclature. A consensus statement of the European Laryngological Society Marc Remacle9 · Christoph Arens1 · Mostafa Badr Eldin2 · Guillermo Campos3 · Carlos Chiesa Estomba4 · Pavel Dulguerov6 · Ivana Fiz7 · Anastasios Hantzakos8 · Jerôme Keghian9 · Francesco Mora11 · Nayla Matar10 · Giorgio Peretti11 · Cesare Piazza12 · Gregory N. Postma13 · Vyas Prasad14 · Elisabeth Sjogren15 · Frederik G. Dikkers5 Received: 5 June 2017 / Accepted: 8 August 2017 / Published online: 17 August 2017 © Springer-Verlag GmbH Germany 2017 Abstract Acronyms and abbreviations are frequently used ­CO2 TOLMS or CO­ 2 laser transoral surgery only (with a in otorhinolaryngology and other medical specialties. ­CO2 handpiece) would be defned as ­CO2 TOLS. KTP transnasal laser-assisted transoral surgery of the pharynx, the larynx fexible laser surgery would be KTP TNFLS. Transoral use and the upper airway is a family of commonly performed of the fexible ­CO2 wave-guide with a handpiece would be a surgical procedures termed transoral laser microsurgery ­CO2 TOFLS. One can argue that these clarifcations are not (TLM). The abbreviation TLM can be confusing because of necessary and that the abbreviation TLM for transoral laser alternative modes of delivery. Classifcation and defnition microsurgery is more than sufcient. But this is not the case. of the diferent types of procedures, performed transorally Laser surgery, ofce-based laser surgery and microsurgery or transnasally, are proposed by the Working Committee are frequently and erroneously interchanged for one another. for Nomenclature of the European Laryngological Society, These classifcations allow for a clear understanding of what emphasizing the type of laser used and the way this laser was performed and what the results meant.
    [Show full text]