Table 4 - uploaded by Ole Reigstad
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All simple arthroscopic procedures during 1999 through 2001 performed at Baerum community hospital were retrospectively examined. Procedures were excluded when being part of more complex procedures. A total of 876 procedures performed on 785 patients were left for examination. Complications were registered from the patient record and all received a...
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Background
We hypothesized that anatomical healing in superior labrum anterior to posterior (SLAP) repair is associated with good clinical outcome. The purposes of this study were to assess the failure rate of anatomical healing after arthroscopic repair of SLAP lesions using computed tomography arthrography (CTA), investigate correlation of the ra...
Citations
... Visualisation techniques have been used for rigid tools such as needles, trocars, and transducers. Robotic surgery would also involve the use of flexible tools [35]. The development of imaging in this direction is essential to locate in real time any type of surgical instrument that the surgeon or robot uses in minimally invasive interventions. ...
Introduction:
The introduction of robotic-guided procedures in surgical techniques has brought an increase in the accuracy and control of resections. Surgery has evolved as a technique since the development of laparoscopy, which has added to the visualisation of the peritoneal cavity from a different perspective. Multi-armed robot associated with real-time intraoperative imaging devices brings important manoeuvrability and dexterity improvements in certain surgical fields.
Materials and methods:
The present study is designed to synthesise the development of imaging techniques with a focus on ultrasonography in robotic surgery in the last ten years regarding abdominal surgical interventions.
Results:
All studies involved abdominal surgery. Out of the seven studies, two were performed in clinical trials. The other five studies were performed on organs or simulators and attempted to develop a hybrid surgical technique using ultrasonography and robotic surgery. Most studies aim to surgically identify both blood vessels and nerve structures through this combined technique (surgery and imaging).
Conclusions:
Ultrasonography is often used in minimally invasive surgical techniques. This adds to the visualisation of blood vessels, the correct identification of tumour margins, and the location of surgical instruments in the tissue. The development of ultrasound technology from 2D to 3D and 4D has brought improvements in minimally invasive and robotic surgical techniques, and it should be further studied to bring surgery to a higher level.
... Despite its advantages, knee arthroscopy can be associated with preventable and unpreventable complications [1,2]. Pneumatic tourniquets are frequently used in arthroscopic knee surgery to facilitate the procedure, improve visualization, reduce operative time, and achieve optimal outcomes. ...
Background/Aim: Tranexamic acid (TXA) is known to reduce intra-articular bleeding during arthroscopic procedures, which can improve visibility and reduce postoperative pain and knee joint swelling from hemarthrosis. However, insufficient data supports the routine use of TXA in arthroscopic meniscectomy. This study aimed to evaluate the effect of a single dose of intravenous (IV) TXA on visual clarity in arthroscopic meniscectomy without a tourniquet. Methods: A randomized, double-blind, controlled trial was conducted to assess the use of TXA for visibility in routine arthroscopic meniscectomy without a tourniquet. Between January 2021 and February 2022, 53 patients undergoing arthroscopic meniscectomy were randomly assigned to either the TXA group (n=27), who received 1 g IV-TXA, or the control group (n=26), who received 100 ml of normal saline. Visual clarity was evaluated using a Numeric Rating Scale (NRS). Patients were also assessed for the need for a tourniquet, tourniquet time, total operative time, volume of irrigation fluid, postoperative pain, hemarthrosis, and knee function on postoperative day 3 and weeks 1, 2, and 4, using the Lysholm knee scoring scale. Results: There was no significant difference in intra-operative arthroscopic visibility between the TXA and control groups (P=0.394). Tourniquet was required in three cases in the TXA group and four cases in the control group (P=0.646). There was no significant difference between the two groups regarding postoperative pain, grade of postoperative hemarthrosis, knee motion, or the Lysholm Knee Score after the operation. Conclusion: The administration of IV-TXA in arthroscopic meniscectomy without a tourniquet did not provide any benefits such as enhanced surgical visualization, reduction in the need to inflate the tourniquet due to obstructed visibility, or decrease in hemarthrosis, VAS pain score, or improved range of motion of the knee in the postoperative period when compared to the control group.
... Indications for performing this procedure include surgically correctable pathologies causing functional complaints and also persisting pain (1) . Pain is usually the major cause of surgery, and it is also considered to be a critical post-operative complication (2,3) . The main purpose of meniscal surgery is to return the studied case to full function without pain (4) . ...
... Data was presented as mean ±SD when it was quantitative and number (percentage) when it was ?? In this table, among meniscal repair group, MRI diagnosed recurrent meniscal tear in 3 cases where there was high intensity signal reaching the articular surface in PHMM of 2 cases and in one case the PHMM showed abnormal meniscal morphology and considered torn. In three cases no abnormality could be detected in PHMM, PHLM & AHLM as shown in figure (2). meniscectomy, less than 25% group, MRI diagnosed recurrent tear in 5 cases where there was high intensity signal reaching articular surface in PHMM of 3 cases & PHLM of two cases and in two cases no abnormality could be detected in PHMM & AHLM. ...
... Abbreviations: PHMM; posterior horn medial meniscus, AHMM; anterior horn medial meniscus, PHLM; posterior horn lateral meniscus, AHLM; anterior horn lateral meniscus. Table (3) showed that among meniscal repair group, MRA confirmed recurrent tear seen as contrast passing through the meniscus in 2 cases (PHMM & AHLM) as shown in figure (2) and no tear was found in 4 cases (in PHMM of 2 cases, AHLM of one case & PHLM in one case) as shown in figure (3). Among meniscectomy, less than 25% group, MRA confirmed recurrent tear seen as contrast passing through the meniscus in 2 cases (in PHMM) as shown in Figure ( In this table, MRI and MRA showed high agreement in meniscal transplant and meniscectomy less than 25% (k=1 and 0.667, respectively), while MRI has low agreement with MRA in meniscal repair and meniscectomy more than 25% (k=0.143 and 0.500, respectively) ( Table 4). ...
... 8 Additionally, increasing valgus force on the knee to open the medial compartment can lead to complications including uncontrolled rupture of the medial collateral ligament (MCL) and femoral fracture. 9,10 Previous studies have described techniques for improving access to the posterior medial meniscus. One such technique is an outside-in percutaneous controlled MCL release, first described in 2004. ...
The posterior horn of the medial meniscus can be challenging to view during arthroscopy because the medial femoral condyle obstructs vision, especially in tight medial compartments. Previous studies have described techniques for improving access, one being a percutaneous medial collateral ligament (MCL) release. This technique allows for increased medial compartment space, which offloads a tight medial compartment, minimizes iatrogenic chondral injury, incomplete meniscal resection, uncontrolled MCL rupture, and allows for accurate diagnosis and management. Studies have proven the safety of the controlled percutaneous MCL release, with no significant postoperative MCL laxity on stress views, no subjective patient instability, fewer iatrogenic cartilage lesions, and no saphenous neurovascular injury. Furthermore, retrospective studies have shown improved postoperative patient-reported outcomes with a controlled percutaneous MCL release in comparison to standard of care without a release. We hypothesize that a controlled percutaneous release of the MCL effectively alleviates some of the pressure within the medial compartment, which could potentially explain the improved postoperative clinical outcomes. This technique also facilitates improved visualization, a decreased risk of iatrogenic chondral injury, and a more complete meniscal resection. The purpose of this Technical Note is to describe our surgical technique and provide surgical pearls for a controlled percutaneous MCL release during knee arthroscopy.
... Se ha reportado una prevalencia cercana a 9% de complicaciones intraoperatorias (daño intraarticular, ruptura de ligamentos, lesión vascular o neurológica, síndrome compartimental, entre otros) 3-5 y alrededor de 1-8% de complicaciones postoperatorias (dolor, infección articular, hemartrosis, trombosis venosa profunda, tromboembolismo pulmonar). [5][6][7][8][9] Un porcentaje importante de estos puede ser por un desconocimiento de la anatomía y errores en la técnica quirúrgica. 10 El cirujano debe tener amplio conocimiento anatómico de la región y dominar la técnica quirúrgica para prevenir errores, por lo que una buena capacitación y entrenamiento es fundamental en su formación. ...
... This will result in a benefit for the patient, such as shorter anesthesia duration, reduced risk of infection, as well as a lesser danger for the incorporation of irrigation fluid used in the context of arthroscopy. [27][28][29] In conclusion, our results demonstrate the usefulness of an arthroscopy training simulator as an important tool for the improvement of surgical and arthroscopic skills in orthopedic resident surgeons and in medical students. Our study shows a fast (steep) learning curve for orthopedic residents and medical students undergoing a standardized training program on a validated virtual reality-based arthroscopy knee training simulator. ...
Background
The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents.
Methods
An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy ( n=24) were compared to a residents group ( n=16). Analyzed parameters were “time to complete a task,” assessment of the movement of tools and values scoring damage to the surrounding tissues.
Results
After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level.
Conclusion
The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand–eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.
... Based on only the arthroscope view, the surgeon performs the surgical procedure. Despite knee arthroscopy being a common procedure (four million knee arthroscopies performed worldwide annually, at a total cost of US$15 billion [1]), it is complex to perform [1] and can lead to several post-surgical complications, such as unintentional femoral cartilage damage or excessive bleeding [2][3][4]. In a recent study, orthopedic surgeons reported having difficulties visualizing some sections of the knee while operating and that a real-time 3D model of the knee structures would be beneficial [1]. ...
This work presents an algorithm based on weak supervision to automatically localize an arthroscope on 3D ultrasound (US). The ultimate goal of this application is to combine 3D US with the 2D arthroscope view during knee arthroscopy, to provide the surgeon with a comprehensive view of the surgical site. The implemented algorithm consisted of a weakly supervised neural network, which was trained on 2D US images of different phantoms mimicking the imaging conditions during knee arthroscopy. Image-based classification was performed and the resulting class activation maps were used to localize the arthroscope. The localization performance was evaluated visually by three expert reviewers and by the calculation of objective metrics. Finally, the algorithm was also tested on a human cadaver knee. The algorithm achieved an average classification accuracy of 88.6% on phantom data and 83.3% on cadaver data. The localization of the arthroscope based on the class activation maps was correct in 92–100% of all true positive classifications for both phantom and cadaver data. These results are relevant because they show feasibility of automatic arthroscope localization in 3D US volumes, which is paramount to combining multiple image modalities that are available during knee arthroscopies.
... Accurate soft-tissue tracking might expand the use of robots in this field, possibly reducing human errors, side-effects, interventional time, operator dependence and surgeon learning curve and fatigue (de Steiger et al., 2015;Reigstad & Grimsgaard, 2006). For more complex and/or deep anatomical structures, such as shoulders or hips, ...
... Based on only the arthroscope view, the surgeon performs the surgical procedure. Despite knee arthroscopy being a common procedure (4 million knee arthroscopies performed worldwide annually, at a total cost of US$15 billion (Jaiprakash et al., 2017)), it is complex to perform (Jaiprakash et al., 2017) and can lead to several post-surgical complications, such as unintentional femoral cartilage damage or excessive bleeding (Curl et al., 1997;Neagoe et al., 2015;Reigstad & Grimsgaard, 2006). In a recent study, orthopedic surgeons reported having difficulties visualizing some sections of the knee while operating and that a real-time 3D model of the knee structures would be beneficial (Jaiprakash et al., 2017). ...
This thesis proposes a novel guidance concept for autonomous surgical robots using ultrasound imaging and advanced artificial intelligence techniques. Automatic real-time interpretation of the images acquired during the operations allows the robots to navigate the surgical space safely and identify the target anatomy correctly. In particular, automatic image quality assessment, outlining and tracking structures and tools, and uncertainty management were implemented in a surgical platform. The first application on the knee through cadaver and volunteer studies showed the feasibility and produced results comparable to clinical standards.
... Knee arthroscopy is one of the most commonly performed orthopedic procedures in the United Kingdom, with an annual rate of 9.9 / 10,000 population [1]. Knee arthroscopy is generally considered minor surgery, most patients are discharged on the same day as surgery and the reported complication rates are low [2], [3]. Despite the overall low risk of complications knee arthroscopy can be complicated by post-operative infection. ...
BACKGROUND: Anticipated changes in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) following uncomplicated knee arthroscopy have not previously been described. AIM: We aim to identify these values to aid the management of patients who re-present with a suspicion of infection. MATERIALS AND METHODS: Patients between 18 and 50 years undergoing day-case arthroscopic knee surgery under the care of the senior authors were recruited. Patients undergoing any bony intervention and those with a known inflammatory arthropathy were excluded from the study. Ethical approval was granted and patients consented to the study. ESR and CRP measurements were performed immediately prior to surgery, then at 1, 7, and 14 days postoperatively. RESULTS: A total of 29 patients consented to the study. A full set of results were achieved for 17 patients. There was a significant increase in CRP on day 1 and day 7 following knee arthroscopy with a mean increase of 4.55 mg/L (P = 0.003) on day 1 and 1.78 mg/L (P = 0.026) on day 7. ESR did not change significantly at any of the measured points. The maximum value for CRP was 16 mg/L on day 1 and 11.5 mg/L on day 7. All CRP measurements had returned to baseline (<5 mg/L) by 14 days. DISCUSSION AND CONCLUSION: Our study suggests that CRP measurement is a useful tool in the investigation of possible joint infection following simple knee arthroscopy. Continued elevation of CRP beyond 14 days or any significant elevation is not usual and suggests an abnormal post-operative recovery, which should prompt further investigation.
... This results in benefits for the patient, such as shorter anesthesia duration, a reduced risk for infection, as well as a lesser danger for the incorporation of irrigation fluid used in the context of arthroscopy. [18][19][20] We acknowledge the following limitations of our study. The use of a training arthroscopy simulator does not allow the clinical outcome of surgeries to be taken into consideration as the training environment differs from that of a daily routine operation room setting. ...
Objective:
Knee arthroscopies are very common orthopedic procedures. For a number of reasons, including increased public awareness for medical errors, patient safety, strict regulations governing duty-hours for residents, surgeons' liability, and an increasing emphasis on the efficient use of operating room time, interest in simulator training is on the rise. It was the purpose of this study to analyze learning curves of medical students and orthopedic resident surgeons using a virtual knee arthroscopy simulator.
Design:
Learning curves of medical students and orthopedic residents were measured perspective using an arthroscopic training simulator for 2 different exercises. Time, camera and probe movement as well as camera and probe roughness were the parameters to be compared. Mean and standard deviation of the initial and the final score for the consecutively performed exercises as well as their slope were reported.
Setting:
The study was performed at the Medical University of Innsbruck, Department of Orthopaedic Surgery. Level of clinical care: institutional.
Participants:
A Students Group (n = 10) consisting of medical students at the Medical University of Innsbruck with no prior knowledge of arthroscopy but interest in orthopedic surgery was selected. The group was compared to a Residents Group (n = 9) which was comprised of orthopedic resident surgeons who had learned arthroscopy in operation courses. All participants involved in the study did several repetitions of the described exercises.
Results:
Both groups improved their skills after several repetitions. Residents were on average faster, moved the camera less, and touched the cortical tissue less than the students. For certain parameters students showed a steeper improvement curve than did residents, because the students started from a different experience level.
Conclusions:
In conclusion, our results demonstrate the usefulness of virtual knee arthroscopy simulators as an important tool for improving surgical and arthroscopic skills in orthopedic resident surgeons, and medical students.
