Introduction: Surgical patients need knowledge to participate in their own care and to engage in self-care behaviour in the perioperative period which is important for their recovery. Patient education facilitates such knowledge acquisition and several methods can be used to facilitate it, for example, face-to-face education and brochures or using information technology such as website or computer games. Healthcare professionals have been slow to seize the possibilities that information technology has to offer within the field, including the use of serious games. To optimise patient education, the information is needed on the patients’ needs and preferences and what they think about the idea of using a serious game to learn about self-care. Aim: The overall aims of this thesis were to describe the knowledge expectations of surgical patients, to describe how surgical patients want to learn, and to explore the potential use of serious games in patient education. Methods: This thesis includes four studies that used both quantitative and qualitative data to describe aspects of patient learning in relation to surgery. Study I has a prospective and comparative design with survey data collected before surgery and before hospital discharge from 290 patients with osteoarthritis undergoing knee arthroplasty. Data was collected on fulfilment of knowledge expectations and related factors. Study II is a cross-­‐sectional study in 104 patients with heart failure who had been scheduled for cardiac resynchronisation therapy (CRT) device implantation. Data was collected on knowledge expectations and related factors. In Study III the perceptions of 13 surgical patients towards novel and traditional methods to learn about post-operative pain management are explored in a qualitative interview study using content analysis. Study IV describes the development and evaluation of a serious game to learn about pain management with the participation of 20 persons recruited from the public. The game was developed by an interdisciplinary team following a structured approach. Data on the efficacy and usability of the game was collected in one session with questionnaires, observations and interviews. Results: Participants reported high knowledge expectations. Knowledge expectations were highest within the bio-physiological knowledge dimension on disease, treatment and complications and the functional dimension on how daily activities are affected, both of which include items on self-care. Most participants wanted to know about the possible complications related to the surgery procedure. In none of the knowledge dimensions the expectations of participants were fulfilled. Participants received most knowledge on the physical and functional issues and received least on the financial and social aspects of their illness. The main predictor of fulfilment of knowledge expectations was having access to knowledge in the hospital from doctors and nurses. Trust in the information source and own motivation to learn shaped how the participants thought about different learning methods. Although the participants were open to using novel learning methods such as websites or games they were also doubtful about their use and called for advice by healthcare professionals. To develop a serious game with the goal to learn about pain management, theories of self-care and adult learning, evidence on the educational needs of patients about pain management and principles of gamification were found useful. The game character is a surgical patient just discharged home from hospital who needs to attend to daily activities while simultaneously managing post-operative pain with different strategies. Participants who evaluated a first version of the serious game improved their knowledge and described usability of the game as high. They were positive towards this new learning method and found it suitable for learning about pain management after surgery in spite of some technical obstacles. Conclusions: Surgical patients have high knowledge expectations about all aspects of their upcoming surgery and although they prefer direct communication with healthcare professionals as a source for knowledge they might be open to try using more novel methods such as games. Preliminary short-­‐term results demonstrate that a serious game can help individuals to learn about pain management, and has the potential to improve knowledge. A careful introduction, recommendation, and support from healthcare professionals is needed for implementation of such a novel method in patient education. / Fræðsla gerir sjúklingum betur kleift að taka þátt í umönnun sinni sem er mikilvægt fyrir bata eftir skurðaðgerð. Sjúklingafræðslu má veita með ýmsum aðferðum, til dæmis munnlega, með bæklingum eða með því að nota upplýsingatækni á formi vefsíðna eða kennslutölvuleikja. Heilbrigðisstarfsfólk hefur verið lengi að tileinka sér möguleika upplýsingatækninnar í sjúklingafræðslu, þar með talið notkun kennslutölvuleikja. Þörf er á meiri þekkingu um fræðsluþarfir skurðsjúklinga en jafnframt um viðhorf sjúklinga til nýrra námsaðferða. Kennslutölvuleikir eru ein leið sem gæti gagnast sjúklingum en notagildi þeirra hefur lítið verið rannsakað. Meginmarkmið þessarar ritgerðar var að lýsa væntingum skurðsjúklinga til fræðslu, lýsa því hvernig þeir vilja læra og að kanna möguleika kennslutölvuleikja í sjúklingafræðslu. Ritgerðin samanstendur af fjórum rannsóknargreinum. Notuð vorumegindleg og eigindleg rannsóknargögn til að lýsa ýmsum hliðum náms einstaklinga sem fara í skurðaðgerð. Rannsókn I er framsýn samanburðarrannsókn sem gerð var á 290 sjúklingum með slitgigt sem gengust undir hnéliðskipti. Gögnum var safnað með spurningalistum fyrir skurðaðgerð og fyrir útskrift af sjúkrahúsi um uppfyllingu væntinga til fræðslu og tengda þætti. Rannsókn II er þversniðsrannsókn með þátttöku 104 sjúklinga með hjartabilun sem voru á leið í aðgerð til að fá ígræddan sérstakan hjartagangráð (e. cardiac resynchronisation therapy (CRT)). Gögnum var safnað með spurningalistum, fyrir ígræðsluna, um væntingar til fræðslu og tengda þætti. Rannsókn III er eigindleg rannsókn með þátttöku 13 sjúklinga sem nýlega höfðu farið í liðskiptaaðgerð eða hjartaskurðaðgerð. Gögnum var safnað með viðtölum þar sem sjúklingar lýstu viðhorfum sínum til nýrra og hefðbundinna aðferða til að læra um verkjameðferð eftir  skurðaðgerð. Gögnin voru greind með innihaldsgreiningu. Rannsókn IV lýsir þróun og mati á kennslutölvuleik til að læra um verkjameðferð eftir skurðaðgerð, með þátttöku 20 sjálfboðaliða. Leikurinn var þróaður af þverfaglegum hópi hjúkrunarfræðinga og tölvunarfræðinga. Gagnsemi og notagildi leiksins voru metin með spurningalistum, áhorfi og viðtölum. Þátttakendur höfðu miklar væntingar til fræðslu. Væntingar voru mestar á sviði lífeðlisfræði um atriði er sneru að sjúkdómi, meðferð og fylgikvillum og á sviði færni um áhrif veikinda á daglegar athafnir. Bæði sviðin fela í sér atriði um sjálfsumönnun. Flestir þátttakendur vildu fá fræðslu um mögulega fylgikvilla skurðaðgerðar. Væntingar voru ekki uppfylltar á neinu þekkingarsviði þó best á sviði lífeðlisfræði og færni en síst er vörðuðu fjárhag og félagslegan stuðning í tengslum við veikindi. Væntingar voru best uppfylltar meðal þeirra sem höfðu góðan aðgang að fræðslu á spítalanum frá hjúkrunarfræðingum og læknum. Viðhorf þátttakenda til mismunandi námsaðferða mótaðist af trausti á fræðslumiðli og eigin áhugahvöt. Þátttakendur voru opnir fyrir notkun nýjunga á borð við vefsíður og kennslutölvuleiki en jafnframt nokkuð tortryggnir og töldu mikilvægt að fá ráðleggingar og aðstoð heilbrigðisstarfsfólks við slíka notkun. Kenningar um sjálfsumönnun og nám fullorðinna, aðferðir leikjahönnunar og tiltæk þekking á fræðsluþörfum sjúklinga um verkjameðferð voru notaðar til grundvallar við hönnun kennslutölvuleiksins. Persóna leiksins er nýlega útskrifuð af sjúkrahúsi eftir skurðaðgerð og þarf að sinna daglegum athöfnum jafnframt því að meðhöndla verki sína. Þátttakendur rannsóknarinnar sem lögðu mat á kennsluleikinn bættu þekkingu sína og töldu nothæfni leiksins mikla. Þeir voru jákvæðir gagnvart þessari nýju námsaðferð og fannst hún henta vel til að læra um verkjameðferð eftir skurðaðgerð þrátt fyrir nokkra  tæknilega örðugleika. Sjúklingar hafa miklar væntingar til fræðslu fyrir skurðaðgerð. Þeir kjósa helst að leita þekkingar hjá heilbrigðisstarfsfólki en eru þó opnir fyrir að prófa nýjungar eins og kennslutölvuleiki. Fyrstu niðurstöður sýndu að kennslutölvuleikur getur hjálpað einstaklingum að læra um verkjameðferð. Við innleiðingu nýjunga innan sjúklingafræðslu er vönduð kynning, meðmæli og stuðningur af hálfu heilbrigðisstarfsfólks mikilvægur fyrir viðtökur sjúklinga. / <p>The online version is a corrected version of the printed thesis. Download the errata list in order to see thecorrections.</p>

Introducción: La anatomía de la fisura labial bilateral es diferente para cada paciente y varios autores han descrito modificaciones de técnicas tradicionales en la búsqueda de obtener un diseño más individual con mejores resultados. Las técnicas de Millard y Mulliken son probablemente las técnicas quirúrgicas más usadas por los cirujanos alrededor del mundo en el manejo de la fisura labial bilateral, sin embargo existen algunas limitaciones en esta técnica en casos bilaterales con asimetría. En ese sentido, se ha diseñado la presente técnica que busca corregir la asimetría en la fisura bilateral. Esta técnica se basa en un doble avance y rotación lateral localizando las cicatrices sobre las líneas naturales del labio entre las unidades estéticas del mismo. Material y Métodos: Este es un estudio retrospectivo del tipo de serie de casos. Este artículo presenta una nueva técnica para el tratamiento quirúrgico de la fisura labial bilateral usada por el autor en 125 pacientes a manera de estudio retrospectivo descriptivo. Esta técnica está basada en el concepto de doble avance y rotación lateral permitiendo el alargamiento del segmento labial lateral más corto. Estas incisiones son ubicadas sobre las líneas naturales del labio, entre las subunidades estéticas del labio superior, en su mayoría. Se evaluaron los resultados obtenidos con esta técnica considerando el número de malos resultados observados a través del seguimiento de los pacientes en un plazo mayor a un año a través del examen físico directo y el análisis de las fotos postoperatorias estandarizadas. Resultados: Desde 2009 al 2011 esta técnica ha sido usada en 125 fisuras labiales bilaterales. Se obtuvo un buen resultado estético y funcional del labio superior y la nariz con esta técnica. Se observaron 15 / 125 (12 %) de malos resultados. Estas son cirugías que necesitaron revisión secundaria mayor. Conclusiones: Una nueva técnica para el tratamiento de formas asimétricas de fisura labial bilateral se describe aquí. Esta es una técnica que permite alargar el segmento labial lateral más corto de la fisura con buenos resultados estéticos en la reconstrucción del labio superior y nariz de la fisura labial bilateral. / Introduction: The anatomy of bilateral cleft lip is different for each patient, and many authors have described modifications of the traditional repairing techniques in order to achieve more individualized designs and better results. The techniques described by Millard and Mulliken are probably the most commonly used all over the world for repairing bilateral cleft lip; however, there are some short-comings when trying to repair asymmetric forms of bilateral cleft lip. So, we designed this technique aiming to correct asymmetry in bilateral cleft lip. This technique is based on a double advancement and lateral rotation concept placing the scars over the natural lines between the esthetic subunits of the upper lip. Matherial and Methods: This is a retrospective and descriptive study based on a case series. We present a new technique used for surgical repair of bilateral cleft lip in 125 patients. The technique is based in the double advancement and lateral rotation concept which allows lengthening of the shortest lateral lip segment. Most of the incisions are performed on the natural lip landmarks, between the aesthetic subunits of the upper lip. Results were assessed considering the number of failures observed after following up patients for more than one year, performing physical examination and analyzing standardized postoperative pictures. Results: This technique has been used in 125 procedures for repairing cleft lip. We obtained good functional and esthetic outcomes for both nose and lips using this technique. The rate of poor results was 15/125 (12%). These latter procedures had to undergo major secondary surgical revisions. Conclusions: We describe a new technique for surgical repair of asymmetric bilateral cleft lip. This technique led to the elongation of the shortest lateral labial segment, allowing us to achieve good esthetic and functional results on upper lip and nose reconstruction in cases of bilateral asymmetric cleft lip.

The current study examined the ability of pain-related catastrophizing to predict outcomes following non-surgical and surgical intervention for temporomandibular disorders (TMDs). The interpersonal context of pain-related catastrophizing, referred to as the communal coping model, was also examined to determine if patient perceptions of punishing and solicitous responses from significant others would moderate or mediate relations between pain catastrophizing and outcomes. The role of pain duration as a moderator of the relation between pain-related catastrophizing and perceived significant other responding was also examined. A total of 94 patients were identified for which 65 had follow-up outcomes that could be examined. Patient follow-up data were obtained at approximately two to three weeks, two to three months, and six months post-intervention. Results showed that pain-related catastrophizing was predictive of greater pain severity at all three follow-up time points after controlling for baseline levels of pain severity, depressive symptoms, sleep disturbance, and pain duration. Pain-related catastrophizing was predictive of poorer range of motion (ROM) at the initial follow-up after controlling for baseline levels of ROM, gender, and form of intervention. Pain-related catastrophizing was not associated with ROM at the second and third post-intervention follow-ups. There was no interaction between pain-related catastrophizing and perceptions of either solicitous or punishing responses in predicting post-intervention pain severity or ROM and any time point. Perceptions of significant other responses also did not mediate the relation between pain-related catastrophizing and post-intervention outcomes at any time point. Additionally, the interaction between pain duration and pain-related catastrophizing in the prediction of post-intervention pain severity or ROM was not significant at any follow-up time point. The findings indicate that pain related catastrophizing is an important predictor of pain severity following non-surgical and surgical interventions for TMDs both initially and in the long-term. Pain-related catastrophizing is related to ROM outcomes only in the short term. Perceptions of punishing and solicitous responses from significant others do not appear to play a role in these associations. The results suggest that patients with high levels of pre-intervention catastrophizing may benefit from adjunctive cognitive-behavioral intervention to attenuate post-intervention pain severity.

One of the most recent advancements in laser technology is the development of ultrashort pulsed femtosecond lasers (FSLs). FSLs are improving many fields due to their unique extreme precision, low energy and ablation characteristics. In the area of laser medicine, ophthalmic surgeries have seen very promising developments. Some of the most commonly performed surgical operations in the world, including laser-assisted in-situ keratomileusis (LASIK), lens replacement (cataract surgery), and keratoplasty (cornea transplant), now employ FSLs for their unique abilities that lead to improved clinical outcome and patient satisfaction. The application of FSLs in medical therapeutics is a recent development, and although they offer many benefits, FSLs also stimulate nonlinear optical effects (NOEs), many of which were insignificant with previously developed lasers. NOEs can change the laser characteristics during propagation through a medium, which can subsequently introduce unique safety concerns for the surrounding tissues. Traditional approaches for characterizing optical effects, laser performance, safety and efficacy do not properly account for NOEs, and there remains a lack of data that describe NOEs in clinically relevant procedures and tissues. As FSL technology continues to expand towards new applications, FSL induced NOEs need to be better understood in order to ensure safety as FSL medical devices and applications continue to evolve at a rapid pace. In order to improve the understanding of FSL-tissue interactions related to NOEs stimulated during laser beam propagation though corneal tissue, research investigations were conducted to evaluate corneal optical properties and determine how corneal tissue properties including corneal layer, collagen orientation and collagen crosslinking, and laser parameters including pulse energy, repetition rate and numerical aperture affect second and third-harmonic generation (HG) intensity, duration and efficiency. The results of these studies revealed that all laser parameters and tissue properties had a substantial influence on HG. The dynamic relationship between optical breakdown and HG was responsible for many observed changes in HG metrics. The results also demonstrated that the new generation of therapeutic FSLs has the potential to generate hazardous effects if not carefully controlled. Finally, recommendations are made to optimize current and guide future FSL applications.

Des avancements récents dans le domaine de la radiothérapie stéréotaxique permettent à un nombre grandissant de patients de recevoir un traitement non-invasif pour le cancer du foie. L’une des méthodes utilisées consiste à suivre le mouvement de la tumeur à l’aide de marqueurs radio-opaques insérés dans le foie grâce au système de suivi de l’appareil de traitement CyberKnife. Or, l’insertion de ces marqueurs est parfois trop invasive pour certains patients souffrant de maladie du foie avancée. Ces patients ont souvent un historique de chirurgie qui permet d’utiliser les agrafes chirurgicales déjà présentes dans leur foie dans le but de suivre leur tumeur. Cette nouvelle approche au traitement des tumeurs du foie est investiguée dans cette étude afin d’en déterminer les paramètres optimaux pour une meilleure pratique thérapeutique. L’expérimentation sur fantôme anthropomorpique a permis de conclure que le contraste des agrafes dans leur milieu augmente lors de l’augmentation des paramètres d’imagerie (kilovoltage et milliampérage de l’appareil de radiographie). D’autre part, l’erreur commise par le système CyberKnife dans l’identification des agrafes pour le suivi a été mesurée comme étant supérieure à celle sur l’emplacement des marqueurs radiologiques de platine (environ 1 mm contre moins de 1 mm). Cette erreur est considérée comme acceptable dans le contexte de ce type de traitement particulier. Enfin, une analyse gamma de l’impact dosimétrique du suivi par agrafes a montré qu’il était approximativement équivalent à celui par marqueurs de platine. De ces observations on conclue que le traitement des tumeurs du foie avec suivi des agrafes chirurgicales est valide et peut être amélioré suivant certaines recommandations cliniques. / Recent progress in stereotactic body radiation therapy allows an ever larger number of people to receive non-invasive treatment for liver cancer. One of the methods that were developed involves tracking the tumor’s movements, using radio-opaque markers which are inserted into the liver of the patient, with the help of the tracking system of the CyberKnife. However, the insertion of these markers is sometimes too invasive for patients with poor liver condition. These patients often have a history of surgery which allows the tracking of surgical clips that are already present in the liver as a surrogate for the tumor. This new approach to treating liver cancer is investigated in the present study in order to identify the optimal parameters for a better practice of this therapy. An anthropomorphic phantom experiment lead to the conclusion that the clip contrast in the tissue increases with an increase of the two imaging parameters (kV and mA of the x-ray tube). In addition, the error that was made on the identification of the position of clips by the CyberKnife system was measured as being slightly superior to the error on platinum marker positions (approximately 1 mm vs less than 1 mm). This error is considered acceptable in the context of this particular type of treatment. Finally, a gamma analysis of the dosimetric impact of clip tracking shows that it is approximately equivalent to that of platinum marker tracking. From these observations, we conclude that the treatment of liver tumors using surgical clips is valid and can be improved following this study’s clinical recommendations.

Different psychosocial factors influence the experience and adaptation to pain. Previous cluster analytic studies using the Minnesota Multiphasic Personality Inventory-2nd edition described psychologically different subgroups of pain patients that had been shown valuable in determining outcome. However, these studies had limited applicability to medico-legal pain populations because they did not use newly developed scales or describe important medico-legal factors that have large effects on symptom endorsement. Using three methods of clustering, the current investigation explored the subgroups that resulted when using all the MMPI-2 and the newly developed MMPI-2-RF (Restructured Form) scales on a large and well-described population of medico-legal spine pain patients. Result demonstrated that the best solution for the current sample was the two-cluster solution when a traditional method was used. However, the best solution was the three-cluster solution when all MMPI-2 scales and a method that used all MMPI-2-RF scales were used. Thus, the three-cluster solution was considered the most adequate solution to differentiate patients in medico-legal settings. Moreover, results demonstrated that subgroup membership was not conditioned to spine related organic factors. Instead, malingering, education, ethnic background and legal status differentiated pain subgroups. Lastly, results demonstrated a dose-response relationship between perceived outcome and subgroup profile elevation. The current results are relevant for understanding the circumstances that can influence spine pain recovery and for informing decisions regarding possible interventions.

Due to the demographic development osteopoorosis is an increasing serious medical and economical problem today in developed industrial countries including Czech republic. Fractures of the proximal femur in the elderly are one of the manifestations of the illness. Within the context of the pharmacological prevention we must consider carefully its contribution in comparison with costs of the fracture treatment in the hospital. This graduation theses deals with evaluation of expenses on the surgical treatment of these fractures and expenses on the pharmacological prevention using Fosamax. This comparison is made in economic situation in Czech republic in the end of the first decade of 21. century

The aim of this thesis was to find out how much and in what way children are prepared for surgical procedures. For the research were selected children at the Department of Paediatric Surgery of the Kolín Regional Hospital, from February to June 2018. In the theoretical part, risk factors for developing anxiety disorders in childhood are described. In particular, anxiety and nervousness, fear, phobia, situational anxiety and mental resilience are defined. A mixed method was used in the research. The main tool was a written questionnaire. In the case of unclear answers, an oral interview was used. In the practical part, two types of questionnaires were used. One is for hospitalized children aged 7-15 and the other for their parents. The research found that seventeen children, out of seventy, were not informed at all, or immediately before surgery. All these children were restless, or even hysterical, they were screaming and crying. The children who were informed of the operation in some way tolerated it quite well. So we can say that most of the children were prepared. Mostly it was only by conversation with parents. The educational material was not used because there is not currently appropriate one.

Introdução: a utilização de luvas cirúrgicas estéreis é uma estratégia fundamental para a prevenção de infecção do sítio cirúrgico e para a proteção da equipe cirúrgica. Entretanto é comum a ocorrência de perfurações de luvas durante os procedimentos cirúrgicos as quais, em sua maioria, não são percebidas pelos profissionais. Objetivos: testar a associação entre a ocorrência de perfuração de luvas cirúrgicas e o número de cirurgiões em campo, o tempo de duração da cirurgia, o tipo de cirurgia, o tipo de abordagem cirúrgica e a especialidade cirúrgica. Materiais e Métodos: trata-se de um estudo de corte transversal realizado num hospital especializado em oncologia do interior paulista. A população do estudo foi composta por 3.966 luvas utilizadas em 359 cirurgias realizadas no referido hospital, no período de 01 de janeiro a 28 de fevereiro de 2018. A avaliação da integridade das luvas cirúrgicas foi realizada por meio de análise visual e da insuflação de líquido, conforme a norma EN 455-1. Os dados foram analisados por meio de estatística descritiva e pela técnica de regressão logística multivariada, utilizando-se o programa estatístico IBM SPSS Statistics versão 21. Resultados: Das 359 cirurgias analisadas, 145 (40,4%) cirurgias apresentaram luvas perfuradas. Das 3.966 luvas coletadas, 254 (6,4%) apresentaram perfuração. Do total de perfurações identificadas, 163 (64,2%) ocorreram na mão esquerda, atingiram o dedo indicador 94 (37,0%). As varáveis associadas à perfuração de luvas identificadas no modelo final foram cirurgias com tempo de duração acima de 120 minutos (OR: 3,06; IC 95%: 1,52 - 6,14) e cirurgias realizadas pelas especialidades da Ortopedia (OR: 4,40; IC95%: 2,36 - 8,20), do Tórax (OR: 3,28; IC95%: 1,75 - 6,17), da Urologia (OR: 2,97; IC95%: 1,53 - 5,76) e do Digestivo Baixo (OR: 2,35; IC95%: 1,22 - 4,54). Ressalta-se que as cirurgias realizadas por vídeo se constituíram num fator de proteção (OR: 0,35; IC95%: 0,22 - 0,56). Conclusão: o presente estudo confirmou a associação entre a perfuração de luvas e tempo de duração da cirurgia acima de 120 minutos e especialidades cirúrgica, além disso, as cirurgias realizadas por vídeo se constituíram como um fator de proteção. Acredita-se que os resultados obtidos poderão subsidiar a proposição de medidas de prevenção e consequentemente contribuir para a segurança dos pacientes e dos profissionais da área da saúde / Introduction: the use of sterile surgical gloves is a fundamental strategy for the prevention of infection of the surgical site and for the protection of the surgical team. However, perforated gloves are common during surgical procedures which, for the most part, are not perceived by professionals. Objective: to test the association between the occurrence of surgical glove perforation and the number of surgeons in the surgery, the duration of the surgery, the type of surgery, the type of surgical approach and the surgical specialty. Materials and Methods: this is a crosssectional study conducted at a specialized hospital in oncology in the state of São Paulo. The study population consisted of 3.966 gloves used in 359 surgeries performed at the referred hospital, from January 1 to February 28, 2018. The evaluation of surgical glove integrity was performed through visual analysis and fluid insufflation, in accordance with EN 455-1. Data were analyzed using descriptive statistics and the multivariate logistic regression technique using the IBM SPSS Statistics version 21 statistical program. Results: of the 359 surgeries analyzed, 145 (40,4%) surgeries had perforated gloves. Of the 3.966 gloves collected, 254 (6,4%) presented perforation. Of the total number of perforations identified, 163 (64,2%) occurred in the left hand, reaching the index finger 94 (37,0%). The variables associated with the perforation of gloves identified in the final model were surgeries with duration time over 120 minutes (OR: 3,06; 95% CI: 1,52 - 6,14) and surgeries performed by Orthopedics specialties (OR: 4,40; 95% CI: 2,36 - 8,20), Thorax (OR: 3.28; 95% CI:1.75 - 6.17), Urology (OR: 2,97; 95% CI: 1,53 - 5,76) and the Low Digestive (OR: 2.35; 95% CI: 1,22 - 4,54). It should be emphasized that the surgeries performed by video were constituted as a protection factor (OR: 0,35; 95% CI: 0,22 - 0,56). Conclusion: the present study confirmed the association between the perforation of gloves and the duration of surgery over 120 minutes and surgical specialties, besides that the surgeries performed by video were constituted as a protection factor. It is believed that the results obtained may support the proposal of preventive measures and consequently contribute to the safety of patients and health professionals

INTRODUÇÃO: Embora a craniotomia pterional e suas variantes sejam os acessos mais utilizados em neurocirurgia, poucos estudos analisaram de forma quantitativa a exposição fornecida em cada uma delas. OBJETIVOS: Neste estudo, realizou-se avaliação comparativa das exposições cirúrgicas fornecidas pelas craniotomias pterional (PT), pré-temporal (PreT) e orbitozigomática (OZ) por meio de medidas quantitativas da área de exposição cirúrgica ao redor círculo arterial do cérebro, exposição angular e exposição linear da artéria basilar na fossa interpeduncular e cisterna pré-pontina. MÉTODOS: Oito cadáveres adultos frescos, com tempo máximo de 24 horas após a morte, foram utilizados no estudo. As craniotomias foram realizadas sequencialmente no mesmo cadáver, em um único lado, iniciando-se com a PT, seguido da PreT e terminando com a OZ. Após cada craniotomia, calculou-se a área de exposição cirúrgica, delimitada pelos seguintes pontos: (1) ponto mais lateral da fissura orbitária superior ipsilateral; (2) bifurcação da artéria cerebral média (ACM) ipsilateral; (3) ponto mais distal da artéria cerebral posterior (ACP) ipsilateral; (4) ponto mais distal da ACP contralateral; (5) ponto mais distal da ACM contralateral; (6) ponto mais lateral na asa menor do esfenoide contralateral. Calculou-se ainda, após cada craniotomia, a exposição angular nos eixos horizontal e vertical das seguintes estruturas vasculares: (1) bifurcação da ACM ipsilateral; (2) bifurcação da artéria carótida interna (ACI) ipsilateral; (3) topo da artéria basilar; (4) ponto médio da artéria comunicante anterior; (5) bifurcação da ACI contralateral; (6) ponto mais distal da ACM contralateral. Por fim, após cada craniotomia, mediu-se a exposição linear da artéria basilar na fossa interpeduncular e cisterna pré-pontina. Todas as aferições foram feitas utilizando-se um sistema de neuronavegação computadorizado. RESULTADOS: A OZ apresentou maior exposição cirúrgica em torno do círculo arterial do cérebro (PT = 844,7 ± 233,3 mm2; PreT = 1.134 ± 223,3 mm2; OZ = 1.301,3 ± 215,9 mm2) com aumento de 456,7 mm2 em relação à PT (p < 0,01) e de 167,4 mm2 comparado com a PreT (p < 0,05). A exposição linear da artéria basilar aumentou significativamente com a extensão da craniotomia PT para a PreT e sequencialmente para a OZ. A extensão da PT para PreT e OZ aumentou a exposição angular em todas as medições. Ao compararmos as craniotomias PreT e OZ encontramos um aumento na exposição angular horizontal do topo da artéria basilar (p = 0,02) e bifurcação da artéria carótida interna contralateral (p = 0,048). CONCLUSÕES: A craniotomia OZ oferece vantagens cirúrgicas significativas em relação à PT e PreT, no que diz respeito à área de exposição cirúrgica e exposição linear da artéria basilar. A remoção de parte da margem orbital e do arco zigomático forneceu aumento significativo da exposição angular, proporcionando maior liberdade cirúrgica para acessar estruturas da fossa interpeduncular, cisterna pré-pontina e cisternas subaracnóideas contralaterais. Os dados apresentados no estudo, somados à experiência do cirurgião podem auxiliar na escolha do melhor acesso cirúrgico para cada lesão a ser tratada / INTRODUCTION: Although pterional craniotomy and its variants are the most used approaches in neurosurgery, few studies have analyzed quantitatively the exposure provided by each of them. OBJECTIVES: In this study we compared the surgical exposures provided by pterional (PT), pretemporal (PreT) and orbitozygomatic (OZ) approaches through quantitative measurements of area of surgical exposure around the circle of Willis, angular exposures, and linear exposure of basilar artery in the interpeduncular fossa and prepontine cistern. METHODS: Eight adult fresh cadavers were used within 24 hours after death. The craniotomies were sequentially performed in the same cadaver, first starting with the PT, followed by the PreT, ending up with the OZ. After each craniotomy the area of surgical exposure was calculated, delimited by the following points: (1) lateral aspect of the superior orbital fissure in the ipsilateral sphenoid wing; (2) bifurcation of ipsilateral middle cerebral artery (MCA); (3) most posterior visible point of the ipsilateral posterior cerebral artery (PCA); (4) most posterior visible point of the contralateral PCA; (5) most distal visible point of the contralateral MCA; (6) most lateral visible point of the contralateral lesser sphenoid wing. After each craniotomy, the angular exposure in the horizontal and vertical axes of the following vascular structures was calculated: (1) bifurcation of the ipsilateral MCA; (2) bifurcation of the ipsilateral internal carotid artery (ICA); (3) basilar artery tip; (4) middle point of anterior communicating artery; (5) bifurcation of the contralateral ICA; (6) most distal point of the contralateral MCA. Finally, after each craniotomy, linear exposure of the basilar artery was measured in the interpeduncular fossa and prepontine cistern. All measurements were performed using a computerized neuronavigation system. RESULTS: OZ presented a wider surgical exposure of the circle of Willis (PT = 844.7 ± 233.3 mm2; PreT = 1134 ± 223.3 mm2; OZ = 1301.3 ± 215.9 mm2) with an increase of 456.7 mm2 in relation to the PT (p < 0.01) and of 167.4 mm2 to the PreT (p < 0.05). The linear exposure of the basilar artery significantly increased with the craniotomy extension to the PreT and then to OZ. The extension from PT to PreT and OZ increases angles in all measurements. When comparing the PreT and OZ we found an increase in the horizontal angular exposure to the basilar tip (p = 0.02) and contralateral ICA bifurcation (p = 0.048). CONCLUSIONS: The OZ approach offered significant surgical advantages compared to the traditional PT and PreT regarding to the area of exposure and linear exposure to basilar artery. With regards to the angular exposure, the orbital rim and zygomatic arch removal provided greater surgical freedom to access structures of the interpeduncular fossa, prepontine cistern, and contralateral subarachnoid cisterns. The data presented in the study added to the experience of the surgeon can help in choosing the best individualized surgical approach