Objectives
Transoral surgery of the larynx with rigid instruments is not always possible. This may result in insufficient therapy or in an increased need for open surgery. For these patients, alternative surgical systems are needed. Here, we demonstrate a curved prototype for laryngeal surgery equipped with flexible instruments.
Study Design
Pre‐clinical user study in an ex vivo porcine laryngeal model.
Methods
The prototype was built from established medical devices, namely a hyperangulated videolaryngoscope and modified flexible instruments as well as three‐dimensional printed parts. Feasibility of laryngeal manipulation was evaluated in a user study (n = 19) with a porcine ex vivo laryngeal model. Using three different visualization technologies, the participants performed various fine motor skills tasks and rated the usability of the system on a 5‐point Likert scale.
Results
Exposure, accessibility, and manipulation of important laryngeal structures were always possible using the new prototype. The participants needed considerably less time (mean, 96.4 seconds ± 6.4 seconds vs. 111.5 seconds ± 4.5 seconds, P = .18), reported significantly better general impression (mean score 3.0 vs. 3.8, P = .041) and significantly lower user head and neck strain (2.6 vs. 1.7, P = .022) using a 40‐inch television screen as compared to a standard videolaryngoscope monitor.
Conclusion
The results indicate that our curved prototype and large monitor visualization may provide a cost‐effective minimally invasive alternative for difficult laryngeal exposure. Its special advantages include avoiding the need for a straight line of sight and a simple and cost‐effective construction. The system could be further improved through advances in camera chip technology and smaller instruments. Laryngoscope, 131:E561–E568, 2021
A retrospective review of sixty children with seventy-eight congenitally dislocated hips who had pre-reduction traction at home was undertaken to assess the effectiveness of the traction and the incidence of severe complications, with specific reference to the incidence and severity of avascular necrosis. Thirty other children with forty-two congenitally dislocated hips who had pre-reduction traction while in the hospital were used as controls. Traction failed to radiologically improve the position of the head in relation to the acetabulum in two hips in each group. The incidence of avascular necrosis was 17.9 percent in hips treated at home and 23.8 percent in hips treated in the hospital. The hospital control group demonstrated higher incidences of the more severe types of necrosis. Traction at home was found to be an advantageous alternative to traction in the hospital, in that it is safe, effective, and less costly; however, it must be stressed that proper patient selection and careful monitoring of the program are required.
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