No abstract

We recommend laparoscopic-assisted placement of the VP shunt in normopressure hydrocephalus patients as a good alternative to the open technique.

The new burden surgical technology must assume demands not only improved efficiency and reduced risk, but also diminished cost and resource utilization. To this end, we have instituted the use of multiple, sequential technologies in complex, minimally invasive procedures: laparoscopic gastric surgery (44 cases), spine procedures (38 cases), and colectomies (96 cases). The technologies include head-mounted display, 3-D optics, robotic arm, harmonic scalpel, and optical access trocars. The combined use of these technologies shortened operative times, diminished use of personnel, and as associated with no technical mishap. Surgeon concentration and control of the operative environment were increased. In an effort to promote combined use of technologies, a structured teaching process was designed and implemented. It required five (average) experiences for efficient, hands-on implementation of combined technologies. We conclude that combined use of sophisticated technologies is safe and efficient; is accomplished by structured, moderately intense educational experience; and diminishes cost and use of human resources.

No abstract

Optical systems which transmit high power density optical radiation present real design and implementation challenges.Sophisticated multi-disciplinary methods have been developed to support the design and analysis of the interaction of the optical radiation field and the transmissive and reflective optics which the field interacts with. The primary effect which results are distributed thermal deformation of the optical surfaces resulting in undesirable aberrations, loss of Strehl and beam "quality". Modern optical systems involve the use of adaptive optical systems which mitigate the effect of these aberrations within their spatial and temporal correction bandwidths. The authors have been involved in a study, which addresses the closed loop correction of thermally induced beam train aberrations using computational numerical models to describe the wavefront effects. This paper reports on the analysis methods used and describes some preliminary results.