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Background and Objective: Three-dimensional heads-up display (HUD) systems have emerged as an alternative to standard operating microscope (SOM) in the operating room. The goal of this study was to quantitatively measure vitreoretinal surgeon posture across visualization methods. Methods: Ergonomic data was collected from 64 cases at two tertiary eye care centers. Surgeons wore an Upright Go 2TM posture training device while operating either using the NGENUITY 3D heads-up display visualization system or the SOM. Results: Total percentage of time with upright posture as primary surgeon was significantly higher in surgeries performed using HUD (median 100%, interquartile range [IQR], 85.1% to 100.0%) as compared to surgeries performed using the SOM (median 60.0%, IQR 1.8% to 98.8%) (P = 0.001, Wilcoxon rank-sum test). Percent time with upright posture was significantly higher in surgeries performed using HUD for two of the three surgeons when assessed independently across systems. Results remained significant when accounting for length of surgery (P < 0.001, multiple linear regression). Conclusions: Ergonomic positioning was improved for surgeons operating using HUD. Given the high prevalence of back and neck pain among vitreoretinal surgeons, increased use of HUD systems may limit musculoskeletal pain and long-term disability from poor ergonomics. [Ophthalmic Surg Lasers Imaging Retina 2024;55:638–645.] [ABSTRACT FROM AUTHOR]

Progress in interventional medicine is associated with the development of more delicate and less invasive surgical procedures, which requires more precise and less traumatic, yet affordable, surgical instruments. Previously we reported on the development of the pulsed electron avalanche knife for dissection of soft tissue in liquid media using the 100 ns plasma-mediated electric discharges applied via a 25 μm disk microelectrode. Cavitation bubbles accompanying explosive vaporization of the liquid medium in front of such a pointed electrode produced a series of craters that did not always merge into a continuous cut. In addition, this approach of surface ablation provided a limited depth of cutting. Application of an elongated electrode capable of cutting with its edge rather than just with its pointed apex faces a problem of nonuniformity of the electric field on a nonspherical electrode. In this article we explore dynamics of the plasma-mediated nanosecond discharges in liquid medium in positive and negative polarities and describe the geometry of an electrode that provides a sufficiently uniform electric field along an extended edge of a surgical probe. A highly enhanced and uniform electric field was obtained on very sharp (2.5 μm) exposed edges of a planar electrode insulated on its flat sides. Uniform ionization and simultaneous vaporization was obtained along the whole edge of such a blade with 100 ns pulses at 4–6 kV. A continuous cutting rate of 1 mm/s in the retina and in soft membranes was achieved at a pulse repetition rate of 100 Hz. The collateral damage zone at the edges of incision did not exceed 80 μm. Negative polarity was found advantageous due to the lower rate of electrode erosion and due to better spatial confinement of the plasma-mediated discharge in liquid. [ABSTRACT FROM AUTHOR]

The article discusses the advantages and disadvantages of micro-operative dentistry. According to the article, under an operating microscope, the structures of the oral cavity can be seen with greater clarity. Also, the use of the operating microscope allows for more ergonomic positions and minimal movement for the clinician and auxiliary staff, reducing the amount of pain and discomfort experienced after a procedure. The use of operating microscopes can improve the quality of restorations, ceramic adaptation, precision of preparations and removal of caries lesions. The article also discusses the proper way of using an operating microscope.

Objective: The aim of this study was to perform a qualitative assessment of the personal video monitor (PVM) as an accessory to the dental operating microscope (DOM). Method and materials: The PVM was attached to a color video monitor, which was already attached to a DOM through a beam splitter. One faculty clinician performed a complete oral examination on a patient wearing a binocular inclinable lens adapted to the DOM under different magnifications, while a second faculty watched the procedure simultaneously using a PVM. After completing the examination, the operators exchanged the viewing devices and repeated the procedure. Results: When compared to a standard binocular lens attached to the DOM, the second operator using the PVM had an unencumbered view of his surroundings and was able to make head movements freely. However, when comparing the resolution of the standard binocular lens to the PVM, the binocular lens provided a sharper picture with better illumination, especially when using higher magnification. Statistical analysis was not incorporated, as the goal of this experiment was to qualify rather than quantify the established PVM resolution, in this initial analysis. Conclusion: The authors concluded that the PVM attached to the video camera and the DOM allowed a second operator to watch the procedure, and it could be used as an important teaching tool. Another application is that the patient may wear the PVM while the procedure is in progress. However, the resolution in the PVM needs to be significantly improved in order to achieve an adequate level of efficiency in four-handed microdentistry. [ABSTRACT FROM AUTHOR]

Background The surgical microscope is an essential tool for microsurgery. Nonetheless, several promising alternatives are being developed, including endoscopes and laparoscopes with video systems. However, these alternatives have only been used for arterial anastomoses so far. The aim of this study was to evaluate the use of a low-cost video-assisted magnification system in end-to-side neurorrhaphy in rats. Materials and methods Forty rats were randomly divided into four matched groups: (1) normality (sciatic nerve was exposed but was kept intact); (2) denervation (fibular nerve was sectioned, and the proximal and distal stumps were sutured—transection without repair); (3) microscope; and (4) video system (fibular nerve was sectioned; the proximal stump was buried inside the adjacent musculature, and the distal stump was sutured to the tibial nerve). Microsurgical procedures were performed with guidance from a microscope or video system. We analyzed weight, nerve caliber, number of stitches, times required to perform the neurorrhaphy, muscle mass, peroneal functional indices, latency and amplitude, and numbers of axons. Results There were no significant differences in weight, nerve caliber, number of stitches, muscle mass, peroneal functional indices, or latency between microscope and video system groups. Neurorrhaphy took longer using the video system ( P < 0.05). The amplitude was higher in the microscope group than in the video group. Conclusions It is possible to perform an end-to-side neurorrhaphy in rats through video system magnification. The success rate is satisfactory and comparable with that of procedures performed under surgical microscopes. [ABSTRACT FROM AUTHOR]

Background The surgical microscope is still essential for microsurgery, but several alternatives that show promising results are currently under development, such as endoscopes and laparoscopes with video systems; however, as yet, these have only been used for arterial anastomoses. The aim of this study was to evaluate the use of a low-cost video-assisted magnification system in replantation of the hindlimbs of rats. Methods Thirty Wistar rats were randomly divided into two matched groups according to the magnification system used: themicroscope group, with hindlimb replantation performed under a microscope with an image magnification of 40x and the video group, with the procedures performed under a video system composed of a high-definition camcorder, macrolenses, a 42-in television, and a digital HDMI cable. The camera was set to 50x magnification. We analyzed weight, arterial and venous caliber, total surgery time, arterial and venous anastomosis time, patency immediately and 7 days postoperatively, the number of stitches, and survival rate. Results There were no significant differences between the groups in weight, arterial or venous caliber, or the number of stitches. Replantation under the video system took longer (p < 0.05). Patency rates were similar between groups, both immediately and 7 days postoperatively. Conclusion It is possible to perform a hindlimb replantation in rats through video system magnification, with a satisfactory success rate comparable with that for procedures performed under surgical microscopes. [ABSTRACT FROM AUTHOR]

A miniature laser ablation probe relying on an optical fiber to deliver light requires a high coupling efficiency objective with sufficient magnification in order to provide adequate power and field for surgery. A diffraction- limited optical design is presented that utilizes high refractive index zinc sulfide to meet specifications while reducing the miniature objective down to two lenses. The design has a hypercentric conjugate plane on the fiber side and is telecentric on the tissue end. Two versions of the objective were built on a diamond lathe--a traditional cylindrical design and a custom-tapered mount. Both received an antireflective coating. The objectives performed as designed in terms of observable resolution and field of view as measured by imaging a 1951 USAF resolution target. The slanted edge technique was used to find Strehl ratios of 0.75 and 0.78, respectively, indicating nearly diffraction-limited performance. Finally, preliminary ablation experiments indicated threshold fluence of gold film was comparable to similar reported probes. [ABSTRACT FROM AUTHOR]

Purpose: To improve the state-of-the-art teaching system by creating surgical videos with synchronised vertical 2-split screens. Methods: An ultra-compact, wide-angle point-of-view camcorder (HX-A1, Panasonic) was mounted on the surgical microscope focusing mostly on the surgeons' hand movements. In combination with the regular surgical videos obtained from the CCD camera in the surgical microscope, synchronised vertical 2-split-screen surgical videos were generated with the video-editing software. Results: Using synchronised vertical 2-split-screen videos, residents of the ophthalmology department could watch and learn how assistant surgeons controlled the eyeball, while the main surgeons performed scleral buckling surgery. In vitrectomy, the synchronised vertical 2-split-screen videos showed the surgeons' hands holding the instruments and moving roughly and boldly, in contrast to the very delicate movements of the vitrectomy instruments inside the eye. Conclusions: Synchronised vertical 2-split-screen surgical videos are beneficial for the education of young surgical trainees when learning surgical skills including the surgeons' hand movements. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The need for medical resources is unparalleled by the resources availability, thus the allocation should be fair and effective, respecting medical and ethical criteria. While macro- and meso-allocation are beyond the reach of the individual doctors, the microallocation entitles doctors to treat patients using the local limited resources and following the ethical guidelines, to the patients' best interest. The herein case discussion shows the use of a single operating microscope in a department of plastic surgery, for concomitant elective and emergency operations, the ethical criteria, and the algorithm for solving the competing claim and the implications thereunder, as well as guidelines for improvement. The appropriate allocation of the microscope requires an efficient coordination of elective operations and emergency patients, medical staff and infrastructure in order to maintain the standard of treatment despite material limitations. Surgeons should be proficient in using the microscope and other alternative magnification devices (loupes), the hospital should have clear rules, explicitly communicated to patients, about resources allocation; surgeons' cross-talk should be the basis for microscope sharing; referring the patients should happen whenever the correct treatment is unattainable. National guidelines and protocols for complex cases treatment should precede the creation of a network of performant referral centers, showing resilience in taking cases according to resource availability. To our knowledge, this is the first report addressing the use of a single microscope for two patients, the ethical dilemmas involved and the first proposal for an algorithm to answer the competing claims raised by this situation. Further inputs from professionals are needed to perfect the algorithm. [ABSTRACT FROM AUTHOR]

Introduction: Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular lesion, and the literature is sparse. Most authors insist that simple disconnection of arteriovenous shunting is enough to treat intracral single-channel pial AVF in most cases, either by microsurgery or endovascular embolization without resection of entire vascular malformation. Discussion: We report an insidious onset of peri-lesional edema formation after abrupt disconnection of AVF shunting with surgical arterial ligation. Treatment entailed anti-platelet and anti-coagulation agent to slow down thrombus formation in intracranial dual-channel pial AVF. We suggest that slowing down thrombus formation in the large varix with anti-platelet and/or anti-coagulation agents seems to be necessary in case of abrupt disconnection of shunting in intracranial single- or dual-channel pial AVF to prevent postoperative cerebral edema or infarction. [ABSTRACT FROM AUTHOR]

Background Microsurgical techniques are considered standard procedures in reconstructive surgery. Although microsurgery by itself is defined as surgery aided by optical magnification, there are no guidelines for determining in which clinical situations a microscope or loupe should be used. Therefore, we conducted standardized experiments to objectively assess the impact of optical magnification in microsurgery. Methods Sixteen participants of microsurgical training courses had to complete 2 sets of experiments. Each set had to be performed with an unaided eye, surgical loupes, and a regular operating microscope. The first set of experiments included coaptation of a chicken femoral nerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluation of the sutured nerves and vessels were performed by 2 experienced microsurgeons using an operating microscope. Results The 16 participants of the study completed all of the experiments. The nerve coaptation and vascular anastomoses exercises showed a direct relationship of error frequency and lower optical magnification, meaning that the highest number of microsurgical errors occurred with the unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between the number of mistakes and magnification, and this relationship was very strong (P<0.01) for vascular anastomoses. Conclusions We were able to prove that microsurgical success is directly related to optical magnification. The human eye's ability to discriminate potentially important anatomical structures is limited, which might be detrimental for clinical results. Although not legally mandatory, surgeries such as reparative surgery after hand trauma should be conducted with magnifying devices for achieving optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy has familiarized most surgeons with the benefits of a surgical video system, including the ability to magnify fine structures, to display the operative field on a monitor for improved intraoperative communication, and to capture video footage for documentation and education. Use of intraoperative video systems during open surgery is far less common and the potential benefits of this have not been well explored. In this report we describe a simple video system that is applicable to both laparoscopic and open surgery. Methods: We employed a standard laparoscopic HD camera (1080p) and telescope for initial laparoscopy. In cases requiring laparotomy, a mechanical arm is attached to the operating table and the camera is mounted without the telescope; this provides video display of the open surgical field. In cases requiring dissection or anastomosis of minute structures, a prototype telescope made for open cases is attached to the same camera; this provides improved magnification and illumination for the surgeon. Microsurgical components can then proceed with the surgeon working off the video monitor at a more convenient posture and with the benefits of video display. Results: This multifunctional HD video system for open abdominal surgery has been utilized in 98 complex hepatopancreaticobiliary surgeries. Clear benefits include (1) improved intraoperative communication, (2) improved teaching of bystanders, (3) improved visualization of minute structures, and (4) improved capture and utilization of surgical video and images for education. In an analysis of patients who underwent pancreaticoduodenectomy (PD) with this system, there was a trend toward fewer pancreatic leaks and shorter length of stay but slightly longer operative time compared to PD prior to implementation of this system. Conclusions: This system can be employed with little added cost over a standard laparoscopy setup and has the potential to be widely utilized in surgical education programs. [ABSTRACT FROM AUTHOR]

Abstract: Focused ion beam (FIB) milling is the micro and nano scale manufacturing process, in which components are fabricated with the micro and nano scale resolution. Micro surgical instruments, micro machining tools, probes of scanning probe microscopy and various other small sized components are fabricated using FIB milling. Due to the favorable properties like hardness and wear resistance, high speed steel (HSS) is one of the choices to fabricate many small scale components. While fabricating small scale components, a part of removed material redeposit onto the machined surface, which is known as redeposition. One of the effects of redeposition is that it impairs dimensional accuracy of work material. HSS work material is investigated for the effect of redeposition during FIB milling and existing mathematical model of depth of sputtering has been modified to take into account the effect of redeposition. The ratio of rate of redeposition to the beam velocity has been evaluated for different beam velocities to validate the modified mathematical model of depth of sputtering and more accurate results of depth of sputtering are achieved with the modified model. [Copyright &y& Elsevier]

Abstract: Introduction: Hard-tissue debris is accumulated during rotary instrumentation. This study investigated to what extent a calcium-complexing agent that has good short-term compatibility with sodium hypochlorite (NaOCl) could reduce debris accumulation when applied in an all-in-one irrigant during root canal instrumentation. Methods: Sixty extracted mandibular molars with isthmuses in the mesial root canal system were selected based on prescans using a micro–computed tomography system. Thirty teeth each were randomly assigned to be instrumented with a rotary system and irrigated with either 2.5% NaOCl or 2.5% NaOCl containing 9% (wt/vol) etidronic acid (HEBP). Using a side-vented irrigating tip, 2 mL of irrigant was applied by 1 blinded investigator to the mesial canals after each instrument. Five milliliters of irrigant was applied per canal as the final rinse. Mesial root canal systems were scanned at high resolution before and after treatment, and accumulated hard-tissue debris was calculated as vol% of the original canal anatomy. Values between groups were compared using the Student''s t test (α < .05). Results: Irrigation with 2.5% NaOCl resulted in 5.5 ± 3.6 vol% accumulated hard-tissue debris compared with 3.8 ± 1.8 vol% when HEBP was contained in the irrigant (P < .05). Conclusions: A hypochlorite-compatible chelator can reduce but not completely prevent hard-tissue debris accumulation during rotary root canal instrumentation. [Copyright &y& Elsevier]

Abstract: Introduction: Complete endodontic system disinfection requires the removal of vital and necrotic pulp tissue, microorganisms, and toxins. The purpose of this study was to compare the effects of 2 ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of extracted teeth. Methods: Two simulated lateral canals each were created 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360). To resemble the clinical situation, a closed system was created in each tooth. The teeth were randomly assigned to 3 experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). Samples were evaluated by direct observation of still images recorded under a dental operating microscope. To examine irrigating solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the root canals. Results: The results showed a significantly higher (P < .05) penetration of irrigant into the lateral canals in the CUI group. PUI and CUI did not differ significantly in solution penetration into the apical thirds of the main canals. The PPI group showed a significantly lower penetration of sodium hypochlorite into the main and lateral canals compared with the CUI and PUI groups. Conclusions: CUI as a final rinse significantly increased the penetration of irrigating solution into simulated lateral canals. [Copyright &y& Elsevier]

The article discusses a study which assessed the feasibility of using endoscope-assisted microsurgery for the extraction of vestibular schwannoma in the internal auditory canal (IAC). It states that the study was performed on 73 patients in whom magnetic resonance imaging were done. It also states that the removal of tumor was seen in 14 procedures while remnant tumor under endoscopic observation was extracted in 13 procedures.

Abstract: An optical-based motion sensing system has been developed for real-time sensing of instrument motion in micromanipulation. The main components of the system consist of a pair of position sensitive detectors (PSDs), lenses, an infrared (IR) diode that illuminates the workspace of the system, a non-reflective intraocular shaft, and a white reflective ball attached at the end of the shaft. The system calculates 3D displacement of the ball inside the workspace using the centroid position of the IR rays that are reflected from the ball and strike the PSDs. In order to eliminate inherent nonlinearity of the system, calibration using a feedforward neural network is proposed and presented. Handling of different ambient light and environment light conditions not to affect the system accuracy is described. Analyses of the whole optical system and effect of instrument orientation on the system accuracy are presented. Sensing resolution, dynamic accuracies at a few different frequencies, and static accuracies at a few different orientations of the instrument are reported. The system and the analyses are useful in assessing performance of hand-held microsurgical instruments and operator performance in micromanipulation tasks. [Copyright &y& Elsevier]

CE of brain aneurysms is safer with better outcomes than microsurgical clip ligation. However, the higher recurrence rate may nullify the acute benefits of coiling. Reported here are three patients who underwent surgery to treat their recurrent, previously coiled aneurysm. Intraoperatively, coils were seen extruding from the recurrent regions of each aneurysm and adherent to the surrounding neurovascular structures. These interesting findings question the premise that observation of a recurrent aneurysm is safe. [ABSTRACT FROM AUTHOR]

Summary: We have described a prefabricated radial forearm free flap containing costal cartilage for tracheal reconstruction. The main advantages of this flap are that it requires only one piece of costal cartilage, simple cartilage trimming, and allows the possible reconstruction of both the internal lining and the external resurfacing when the flap itself is folded. This procedure is easy and its outcome is stable. This flap is an attractive option for the reconstruction of large tracheal and skin defects, even in areas previously exposed to surgery or irradiation. [Copyright &y& Elsevier]

Summary: Background: There are discrepancies between authors as far as topography of superior ophthalmic vein in the orbital apex is concerned. Objectives: The aim was to determine the location of the structures within the posterior part of the orbit and in the superior orbital fissure. Material: One hundred preparations of orbits were derived from the corpses sectioned in Forensic Medicine Department, University Medical School in Warsaw, Poland. Study design: Anatomical preparation was performed with use of standard set of microsurgical equipment and operating microscope. Results: Nine various morphological types of the superior orbital fissure were distinguished. Among those were two main categories: type “a” characterised by a clear narrowing within the fissure and type “b” which lacked such narrowing. The type “a” and “b” fissures were also different in length whereby type “b” fissure was significantly shorter. A diversity of positioning of the soft structures within those types was successfully noted. In type “a” the superior ophthalmic vein was located typically, however in type “b” fissures it was significantly more often the lowest structure in the posterior part of the orbital apex (except for muscles and orbital fat). A short case report of patient with superior orbital syndrome was added. Conclusion: Position of soft tissue structures in superior orbital fissure depended on its morphological type. [Copyright &y& Elsevier]

BACKGROUND Mohs micrographic surgery (MMS) represents a promising option for treatment of melanoma in situ (MIS). However, interpretation of melanocytic lesions by fresh frozen sections may be difficult. OBJECTIVE The objective of this study was to determine if margins called clear by MMS were clear by subsequent paraffin-embedded sections and to compare cure rate with available data for MMS and standard excision. MATERIALS AND METHODS A total of 167 patients with MIS, including 116 patients with MIS in sun-exposed skin of lentigo maligna (LM) type, were treated by MMS with subsequent evaluation of the final margin with paraffin-embedded sections that were cut en face, over a period of 12 years. A total of 143 patients were available for follow-up from 6 months to 12 years (mean, 50 months; median 48 months; 594.5 patient-years), and 109 patients were available for follow-up from 2 to 12 years (mean, 63 months; median, 60 months; 569 patient-years). RESULTS The clearance rate by MMS technique using frozen sections was 94.1% for MIS non-LM type, 95.7% for MIS LM type, and 95.1% for both. The cure rate was 97.8% for MIS non-LM type, 99.0% for MIS LM type, and 98.6% for both for mean follow-up of 50 months and 97.4% for MIS non-LM type, 98.6% for MIS LM type, and 98.2% for both for mean follow-up of 63 months. CONCLUSION MMS is a viable option for treatment of MIS that may increase cure rate and reduce the size of the defect especially in cosmetically and functionally sensitive areas. [ABSTRACT FROM AUTHOR]

The field of endodontics has seen vast improvements in technology and techniques over the past several years. Perhaps the one area of endodontics that has improved the most is the way in which surgery is performed. With the use of state-of-the-art instruments, new and improved materials, and a surgical operating microscope, the gap has narrowed between biological concepts and the ability to achieve consistently successful clinical results. The practice of these techniques is now referred to as endodontic microsurgery. [ABSTRACT FROM AUTHOR]

This paper describes the experimental results on static and dynamic bending motions of all polydimethylsiloxane (PDMSJ pneumatic microfinger. The proposed pneumatic microfinger consists of two PDMS diaphragms with different thicknesses or material properties. The microfinger is fabricated through PDMS molding process and the PDMS-to-PDMS bonding process. The out-of-plane motion of the microfinger is achieved by using the pulling force of the inflated actuator diaphragms while the square wave pneumatic force is supplied to the balloon actuators. In the case of the microfinger with different thickness of two diaphragms, the pressure-dependent dual-bending motion of the microfinger is available. The proposed working principle is confirmed from the steady-state bending angle measurement of the two types of the microfingers with different thicknesses of the bottom PDMS layers. While the pneumatic force is less than 20 kPa, the top diaphragm of Type A microfinger is fully inflated and the microfinger moves downward. Around 20 kPa, the bending direction of the microfinger starts to be changed from downward to upward. The microfinger with two types of PDMS films with different mixing ratio of base polymer and curing agent is also proposed for the improvement of the PDMS-to-PDMS bonding strength, the material property change, and the rapid manufacturing process. The microfinger moves only upward because the top PDMS diaphragm with excess of silicon hydride group is relatively stiffer than the bottom PDMS diaphragm with excess of vinyl group. The dynamic bending motion of the single microfinger and the object-lifting motion of the microfinger array are observed to evaluate their performance. The dynamic bending angle of the microfinger with golden air bone length is about 179° at 1 Hz, while the square wave input pressure of 250 kPa is supplied to finger structure. [ABSTRACT FROM AUTHOR]

Suter B, Lussi A, Sequeira P.Probability of removing fractured instruments from root canals.International Endodontic Journal,38, 112–123, 2005.To evaluate in a clinical case series the location of fractured instruments, how many of them could be removed and to compare these findings with the results of a similar study.Within an 18-month period all referred endodontic cases involving fractured instruments within root canals were analysed. The protocol for removal of fractured instruments was: create straight-line access to the coronal portion of the fractured instrument, attempt to create a ditched groove around the coronal aspect of the instrument using ultrasonic files and/or to bypass it with K-Files. Subsequently, the fractured instrument was vibrated ultrasonically and flushed out of the root canal or an attempt was made to remove the instrument with the Tube-and-Hedström file-Method or similar techniques. The location of the fractured instrument and the time required for removal were recorded. Successful removal was defined as complete removal from the root canal without creating a clinically detectable perforation.In total, 97 consecutive cases of instrument fracture were included in the time period. In all, 84 instruments (87%) were removed successfully. There was a significant correlation between the time needed to remove fractured instruments and a decrease in success rate. Curved canals had significantly more fractured instruments than straight canals (P < 0.05). Rotary instruments fractured significantly more often in curved canals (P < 0.05) compared with other instruments. Half of all instrument fractures occurred in mesial roots of lower molars and most often when using rotating instruments. There was no statistically significant difference in the success rate with respect to the location of the fractured instrument (tooth/root type), the type of fractured instrument or the different methods of instrument removal.Curved canals are a higher risk for instrument fracture than straight canals. In curved canals rotary instruments (including lentulo spirals) fractured more often than other instruments. In all, 87% of the fractured instruments were removed successfully. A decrease in success rate was evident with increasing treatment time. The use of an operating microscope was a prerequisite for the techniques used to remove the fractured instruments. [ABSTRACT FROM AUTHOR]

In this article, the authors focus on the benefits of using microsurgical duvet during microsurgery of free flap. They inform that microsurgical duvet consists of three elements including a cotton wool Gamgee, a disposable sterile drape and a disposable adhesive tape strip. They mention that the duvet helps to maintain intraoperative skin temperature by reducing thermal loss.

Thorough knowledge of aberrant root canal anatomy is critical for successful endodontic treatment. Many case reports of middle mesial canal in mandibular first molar have been published, however presence of middle distal canal in distal root of mandibular first molar is rare. This case report describes successful endodontic management of a mandibular first molar with five root canals (two mesial and three distal canals). The use of an operating microscope for detection of additional root canal orifices in complicated cases is recommended. [ABSTRACT FROM AUTHOR]

The author reflects on several aspects of the transanal endoscopic microsurgery (TEM) platform that was originally developed for treating villous adenomas, and mentions that the extension of TEM to treat neoplastic lesions in patients unfit for surgery is not accepted as a standard. He comments on the transanal endoscopic microsurgery set from medical equipment maker Karl Storz. An overview of the TransAnal Minimally Invasive Surgery (TAMIS) is offered.

In this article, the author discusses recent developments in minimally invasive vitreo retinal surgery techniques. Topics discussed include inclusion of the smaller gauge vitrectomy techniques hastening recovery phase and advent of the 27-G instrument system providing new dimension to microsurgery. He also discusses risks associated with new technological advances in surgery techniques.

A letter to the editor is presented which discusses the use of bubble wraps in training for microsurgery.

A microsurgical suction tube with an attached ball probe has been developed. It functions as a microdissector when the ball probe is in its extended position, creating a larger working field than an ordinary sucker. When the ball probe is in the repose position, it does not interfere with the suction capacity, and the suction tube serves as a regular sucker. By adding the properties of the microdissector to the suction tube, dissection of exquisitely fine and subtle structures, including arachnoidal membranes, is facilitated. The ball probe is easily dismantled from the suction tube and the whole instrument conveniently cleaned. [ABSTRACT FROM AUTHOR]

Summary: Late failure of microsurgical flaps is a rare event and it has been reported as a consequence of compression of the vascular pedicle or late infection. We report a case of late partial failure occurring 3 weeks post-operatively which was shown by vascular imaging to be caused by a previously unidentified complete occlusion of the right external iliac artery. After successful vascular bypass surgery, the suffering flap developed granulation tissue and was skin grafted. In patients carrying multiple risk factors for peripheral vascular disease, the risk of proximal vessel occlusion as a cause of flap failure, should be kept in mind. [ABSTRACT FROM AUTHOR]

The article reports on the ophthalmological devices provided by ophthalmologist Jonathan D. Walker and volunteer colleagues to the Centro Nacional de Oftamologia (CENAO), the only teaching and charity hospital in Nicaragua. The opthalmological equipment given include operating microscopes, surgical machines, lasers and slit lamps. Walker believes that medical equipment donations to developing countries help physicians provide universal and sustainable eye care in the countries.

Focuses on the pregnancy rate after reversal of vasectomy in Great Britain. Emphasis on the milking of epididymis before anastomosis; Risk of sperm leakage and granuloma; Importance of microsurgical equipments.