Rotational technique and microsurgery

Weinrib, Harry P.; Cook, John Q.

doi:10.1002/micr.1920050408

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…Any kind of fixed support can be placed close to the operative site for hand support. Non-dominant hand is able to play a more active role during practice [11]. …”

Section: Discussionmentioning

confidence: 99%

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

Tamrakar

2017

Cureus

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Microvascular anastomosis procedure has become an essential practice for the management of most neurovascular diseases. Increasing use of neurosurgical techniques necessitates intensive laboratory training in microsurgery.Umbilical artery is used for quantifiable representation to set up microvascular anastomosis model for the beginners. These arteries are found to be between 4 and 5 mm in diameter. Chicken wings are set up as second anastomosis model. Five to six centimeter long brachial artery extracted from a chicken is measured approximately 1-2 mm in diameter. These arteries are practiced for end-to-end, end-to-side, or side-to-side anastomosis under the microscope.Umbilical cord and chicken wing model hold several advantages. These essentials are inexpensive, convenient to manage, and easy to obtain for educational purposes. They neither need detailed facilities for maintenance like in animal model nor any anesthetic prerequisite. Moreover, the diameter and structure of the material are identical to those of human cortical vessels.Low-cost laboratory training during residency is more relevant in source restraint areas. It has several added benefits in refining the procedural dexterity on anastomosing smaller size vessel identical to a cortical vessel of middle cerebral artery and distal branches of the superficial temporal artery.

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“…Any kind of fixed support can be placed close to the operative site for hand support. Non-dominant hand is able to play a more active role during practice [11]. …”

Section: Discussionmentioning

confidence: 99%

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

Tamrakar

2017

Cureus

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“…144 Remedies are correlative to the wrong, 145 and are closely tied to the structure and extent of the wrong and the position to be restored. 146 Settler law undertakes "restorative" or "rectificatory" functions that conceptualise remedies as "undoing" a wrong. 147 Settler law's remedies operate under a necessary legal fiction, that perhaps reflects the fungibility of the economic resources with which they primarily deal; a remedy is seen to undo a wrong, and after a matter is closed, the harm's effects are considered erased.…”

Section: The Correction: Utumentioning

confidence: 99%

Rebalancing Wrongs: Towards a New Law of Remedies for Aotearoa New Zealand

Hughes¹

2022

VUWLR

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Tikanga Māori is a central pillar of Aotearoa New Zealand and the common law is developing to reflect that. A new era of law is emerging, informed by both tikanga Māori and settler law. While this is an important, positive step towards establishing an appropriate domestic jurisprudence of Aotearoa New Zealand, misguided integration, no matter how well intentioned, is harmful. The ongoing collision between tikanga Māori and settler law in a legal context must be navigated carefully. It gives rise to the need for specific examination of different areas of law to consider how the two systems might interact. This article examines the law surrounding remedies and considers whether and how remedial structures in tikanga Māori and settler law might be reconciled. It undertakes a broader structural analysis and a closer examination of the specific aims of each remedial framework. Overall, it argues that, with a shift in underpinning rationale to one informed by tikanga Māori, existing common law remedies may be applied in ways consistent with, and that give effect to, tikanga Māori. Despite tensions between the two frameworks, the flexibility within both tikanga Māori and the settler common law is sufficient to allow them to come together into a new law of remedies in Aotearoa New Zealand.

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“…Bethlehem Bridge or any other fixed support can be placed close to the operative site for hand support. 43 Rotational technique, 44 two-handed manipulations, proper microsurgical training and experience, robot hand technique, 45 avoiding physical exertion, 46 proper instrument design, 47 self-retracting brain retractors, 28 β-blocker, 48 computer-controlled manipulation, 49 and telerobotic tools 50 can reduce tremors. A rotational technique to manipulate microsurgical instruments can also suppress tremor and can help relax the hand for a long time.…”

Section: Physiologic Tremor and Precisionmentioning

confidence: 99%

“…The nondominant hand is able to play a more active role in the operation. 44 Robots permit unprecedented precision of tool manipulation and filter tremors. They have evolved from stereotactic fine suture, indigenous model, and knot tying and untying techniques can be used for training.…”

Section: Physiologic Tremor and Precisionmentioning

confidence: 99%

Microneurosurgical Skills Training

Yadav

Parihar

Ratre

et al. 2015

J Neurol Surg A Cent Eur Neurosurg

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Microneurosurgical operations differ from other surgery. Longer operative time, narrow and deep-seated operative corridors, hand-eye coordination, fine manipulation, and physiologic tremor present special problems. Proper understanding of visual feedback, control of physiologic tremor, better instrument design, and development of surgical skills with better precision is important for optimal surgical results. Using the pen-type precision grip with well-supported arm, wrist, hand, and fingers avoids fatigue and improves precision. Proper instrument design, patient positioning, hemostasis techniques, tilting operative table, good operative microscope, an adjustable chair, careful use of suction tube, bipolar forceps, and brain retraction play important roles in microneurosurgery. Sufficient clinical case volume or opportunity during routine operative hours may not be available in the beginning for young neurosurgeons; microsurgical training using various models can enable them to gain experience. Training models using deep-seated and narrow operative corridors, drilling, knot-tying technique, and anastomosis using fine sutures under high magnification can be practiced for skill improvement. Training laboratory and simulation modules can be useful for resident training and skill acquisition. Indigenously made inexpensive models and comparatively less expensive microscopes can be used in resource-constrained situations. The maintenance of microsurgical ability should be preserved by staying active in operative practice. The knowledge of ergonomics, proper training, observing hand movements of skillful surgeons, and the use of operative videos can improve skill. Endoscopic assistance, computer-assisted robot hand technique, and microtechnology can provide access to the smallest areas of the body.

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Rotational technique and microsurgery

Cited by 6 publications

References 2 publications

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

Rebalancing Wrongs: Towards a New Law of Remedies for Aotearoa New Zealand

Microneurosurgical Skills Training

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