Este estudo, realizado em um hospital geral e privado, teve como objetivos identificar problemas apresentados pelos pacientes cirúrgicos após a alta hospitalar, correlacioná-los com a assistência perioperatória e discutir ações possíveis pela enfermagem para a melhoria da evolução dos pacientes após a alta hospitalar. A população foi constituída de 112 pacientes submetidos a cirurgias eletivas no período de março a maio de 2004. Os dados foram obtidos dos prontuários e de entrevista com os pacientes, buscando informações sobre problemas apresentados e aspectos da assistência prestada referentes a: cirurgia, anestesia, preparo pré-operatório, períodos de permanência hospitalar pré e pós-operatória, visitas pré e pós-operatórias dos profissionais relacionados ao processo cirúrgico, momento das visitas, orientações recebidas para alta, entre outros. Os resultados mostraram que 69,6% dos pacientes relataram problemas, relacionados a alterações emocionais e fisiológicas e dúvidas. O mais freqüente referiu-se à ferida cirúrgica, que correspondeu às principais queixas relatadas. Dentre os problemas, 5,3% demandou re-internação. Os resultados referentes à assistência perioperatória apontam relação de alguns fatores com os problemas relatados. As orientações para a alta mostraram-se incompletas. Considerou-se que, na maioria dos casos, os períodos de permanência hospitalar pré e pós-operatórias são curtos e não favorecem momentos e locais formais para o preparo, avaliação e orientações ao paciente. O período pós-operatório é ainda mais curto, pelo tempo demandado para a recuperação anestésica que, neste estudo, predominaram aquelas mais complexas. Houve associação significativa entre período pós e tipo de anestesia. Não foram todos os pacientes que receberam visitas, nestas fases, por profissionais diretamente envolvidos com processo cirúrgico e, dentre os que receberam, foram significativas aquelas realizadas apenas no centro cirúrgico, principalmente entre os anestesiologistas. Os problemas após a alta que demandaram internação ocorreram em pacientes que não receberam visita pré-operatória pelo cirurgião e anestesiologista. Os pacientes só retornam ao hospital quando complicações já ocorreram. A alta do processo cirúrgico, portanto, ocorre no consultório do cirurgião e o hospital não tem condições de participar na prevenção dos problemas após a alta. Com o avanço da tecnologia, o processo cirúrgico se modificou. As intervenções cirúrgicas são cada vez mais rápidas, permitindo o restabelecimento em menor tempo. Por outro lado, o processo cirúrgico tem sido realizado em vários locais, além do hospital, podendo determinar “vácuos” nas etapas da assistência perioperatória e favorecer problemas, tanto durante a fase transoperatória quanto pós-operatória. Configura-se a necessidade de novas estratégias assistenciais que garantam a integralidade deste processo. E a enfermagem pode ser uma destas estratégias, como elo de integração entre paciente/família/hospital/médico. A determinação de momentos formais para avaliação e orientações ao paciente, tanto na fase pré-operatória quanto pós-operatória, deve ser considerada, visando atender às expectativas e necessidades dos pacientes como demonstrado neste estudo / This study, carried through in a general and private hospital, aimed at identifying problems presented by the surgical patients after being released from the hospital, connecting them with the perioperative assistance and discuss possible nursing actions for the improvement of the patients´ evolution after hospital release. The population was composed of 112 patients submitted to elective surgeries in the period from March to May, 2004. The data had been obtained from the patients´ records and from interviews with the patients, searching information on the problems presented and aspects of the assistance given referring to: surgery, anesthesia, preoperative preparation, pre and after operative periods of hospital staying, pre and after daily visits from the professionals related to the surgical process, time of the visits, guidances received for hospital release, among others. The results had shown that 69.6% of the patients presented problems, related to the emotional and physiological alterations and doubts. The most frequent referred to the surgical wound, which corresponded to most of the related complaints. Amongst the problems, 5.3% demanded re-hospitalization. The results concerning the perioperative assistance indicate a relation of some factors with the stated problems. The releasing guidances had revealed incomplete. In most of the cases it was considered that the pre and after operative periods of hospital staying are short and do not support formal moments and places for the preparation, evaluation and guidances to the patient. The after surgical period is still shorter, due to the time demanded for the anesthetical recovery which, in this study, the most complex ones had predominated. There was a significant association between the after operative period and type of anesthesia. In those phases, not all the patients had received visits from the professionals directly involved with surgical process and, amongst those who received, most of them were carried through only in the operating room, mainly amongst the anesthesiologists. The problems presented after the release that demanded hospitalization had occurred in patients who had not received preoperative and the anesthesiologist´s daily visit. The patient only come back to the hospital when complications had already occurred. Therefore, the surgical process release occurs in the surgeon\'s office, and the hospital has no conditions to take part into preventing the problems after the release. With the advance of the technology, the operative process has been altered. Surgical interventions have been faster over and over, allowing the recovery in lesser time. On the other hand, the surgical process has been carried through in some places, besides the hospital, being able to determine the \"chasms\" in the perioperative assistance stages, and fomenting problems, not only during the transoperative period, as well as during the after surgical one. The need for new assistencial strategies was noticed, which would guarantee the completeness of this process. And nursing can be one of those strategies, as a link of integration between patient/family/hospital/surgeon. The determination of the patient´s formal moments for evaluation and guidances, not only during the pre and after surgical phases, must be considered, aiming at answering the patients´ expectations and needs as shown in this study

O aprendizado e o ensino da cirurgia veterinária envolvem o desenvolvimento de habilidades que podem ser obtidas em laboratórios, por meio de vários modelos já disponíveis, incluindo o treinamento em cadáveres. Nestes, quando comparados aos procedimentos em animais vivos, duas limitações são notadas e frequentemente mencionadas, e referem-se às alterações de consistência dos tecidos e à ausência de sangramento durante o treinamento cirúrgico. Este trabalho foi focado na superação destas questões, por meio da realização da simulação de circulação sanguínea em cadáveres adequadamente preservados, permitindo aos usuários do sistema a possibilidade de treinamento cirúrgico em um modelo mais próximo do animal vivo, viabilizando também o aprendizado e a prática da hemostasia. Depois de desenvolvido o sistema, o mesmo foi utilizado por estudantes de Medicina Veterinária com distintos níveis de experiência, que avaliaram todo o método por meio de questionário, ressaltando também os pontos positivos e negativos observados. Concluiu-se que é possível realizar a simulação de sangramento em cadáveres quimicamente preservados, e que tal sistema foi bem aceito por quem o utilizou, sendo mais uma alternativa para melhor preparar estudantes para as experiências em animais vivos que necessitem de intervenções cirúrgicas. / Veterinary surgery demands skills acquisition and refinement that can be obtained in laboratories using several available models, including training on cadavers. Those, when compared to live animal procedures, two limitations are noted and often mentioned, and are due to tissue consistency alterations and absence of bleeding during surgical training. This work was focused on overcoming these issues, by performing blood flow simulation in properly chemically preserved cadavers, giving users of this system the possibility of surgical training in a model closer to live animal, also enabling learning and practice of hemostasis. After developed the system, it was used by veterinary students with distinct experience levels, evaluating the whole method through a questionnaire, emphasizing positive and negative aspects. It was concluded that bleeding simulation in chemically preserved cadavers is possible, and that such a system was well accepted by those who used it, being an alternative to better prepare students for experiments on live animals that require surgical interventions.

Infections are a major cause of morbidity and mortality during the post-operative phase of patients’ recovery. Wound infections are the second most commonly encountered type of nosocomial infection. Because wound infections can be introduced by not applying infection control measures and sterile technique principles in the operating room, the implementation of infection control principles is an imperative. The aim of this study was to explore and describe infection control practices related to the prevention of Surgical site infections in the operating rooms in a public health care sector in the Nelson Mandela Bay Municipality. The findings were compared with practices, as indicated in an evidence-based guideline. The research design was quantitative, explorative, descriptive, comparative-descriptive and contextual in nature. The research sample consisted of all the professional nurses, in the operating room. The data were collected by means of a self-administered questionnaire. Descriptive statistics was used to present the data in the form of tables and graphs. Based on the analysis of the data, some recommendations were made for the implementation of infection control practices, in order to prevent Surgical site infections in the operating room.

A dermorrafia é vital para o sucesso do procedimento por ser a última etapa cirúrgica. Este estudo comparou a síntese e o processo de cicatrização de pele em cães com a utilização de três diferentes materiais, fio de náilon (grupo GFN), fio farpado (grupo GFF) e grampo cirúrgico (grupo GGC), após ovariohisterectomia. Foram utilizadas 27 fêmeas caninas aptas a serem castradas eletivamente que não apresentavam comorbidades. Os animais foram divididos randomicamente nos três grupos e submetidos à dermorrafia com os materiais a serem testados. Foram avaliados: o tempo para a sutura da pele, as complicações relatadas pelos tutores e a temperatura local da pele em cicatrização. Foram também avaliados diversos parâmetros clínicos de cicatrização em sete dias de pósoperatório, bem como parâmetros histológicos de biópsias de pele coletadas aos 14 dias. O grampo cirúrgico apresentou o menor tempo (p<0,001) para dermorrafia e a maior ocorrência de deiscências de sutura. O fio farpado apresentou o menor escore (p=0,006) de alterações clínicas aos sete dias de pós-cirúrgico e não apresentou ocorrência de deiscência de sutura. Contudo não houve diferença entre os grupos quanto à avaliação histológica da biópsia cicatricial aos 14 dias. O fio farpado apresentou segurança na sutura e fácil manipulação na dermorrafia de cães, enquanto o grampo cirúrgico utilizado mostrou-se pouco confiável devido ao grau elevado de deiscência. / Dermorrhaphy is vital to the success of the procedure because it is the last surgical step. This study compared the synthesis and the process of skin healing in dogs using three different materials, nylon thread (GFN group), barbed wire (GFF group) and surgical staple [SV1] (GGC group) after ovariohysterectomy. Twenty-seven canine females without comorbidities were electively castrated. The animals were randomly divided into three treatment groups and submitted to dermorrhaphy with the materials to be tested.. The following were evaluated: time to suture the skin with each material, the complications reported by the tutors and the local temperature of the skin in healing process. Several clinical parameters of healing were also evaluated in seven postoperative days, as well as histological parameters of skin biopsies collected at 14 days. The surgical staple showed the shortest time (p<0.001) for dermorrhaphy and the higher occurrence of suture dehiscences. The barbed wire had the lowest score (p=0.006) of clinical changes on the seventh postoperative day and did not presented an occurrence of suture dehiscence. However, there was no difference between the groups regarding the histological evaluation of cicatricial biopsy at 14 days. The barbed wire showed security in the suture and easy manipulation in the dermorrhaphy of dogs, while the surgical staple used proved to be unreliable due to the high degree of dehiscence.

No description available.

<p>Minimally Invasive Robotic Surgery (MIRS) has revolutionized the way modern surgery is conducted by allowing for smaller incisions, finer control, reduced pain, and faster recovery. The state-of-the-art end-effector technology used for MIRS are tools based off of the rigid-body instruments used in traditional ‘open’ surgery. The rigid nature of the end-effectors, specifically the grasping jaws, leads to a lack of force feedback when implemented in a robotic system. </p> <p>Without additional feedback from active sensing, the blanching that occurs from restricted blood flow around a grasping site is the only indication a surgeon can use to assess the force applied to a tissue. Ongoing efforts to develop active force sensing solutions are currently faced with two major obstacles: miniaturization and sterilization. The lack of force feedback causes a gap between intention and result during robotic surgery. </p> <p>This work proposes the introduction of Visual Force Feedback (VFF) through the integration of a compliant end-effector design. Visual Force Feedback is an intuition, developed through practice, that allows a surgeon to estimate the reaction force of a compliant mechanism by the deflection of the outer flexures. An understanding of the relationship between opening size, flexure deformation, and pinch force allows for rapid estimation of the force applied to a manipulated object. </p> <p>Force and dimensional data were gathered through finite element simulation and the finite element model was validated with physical experimentation on a custom test bench. Multiple functions relating the flexure deformation to the reactionary force, referred to as pinch force, for specific opening sizes were resolved. Notable observations made through the analysis of these results were: (1) a closely linear relationship between outer flexure deformation and pinch force in both experimental and computational results and (2) a higher rate of pinch force increase due to draw displacement as an effect of wider jaw opening. These findings are intended to help shrink the gap between intention and result in the field of MIRS.</p>

Osteoid osteomas are common, painful, osteoblast tumors that frequently present in adolescents and young adults. Surgical management is indicated for cases with associated symptoms, such as headaches, dizziness, diplopia, proptosis, sinusitis, and facial deformity. The authors report a case of a 15-year-old male with an enlarging frontal sinus osteoma. Virtual surgical planning was utilized to design a KLS Martin Resorbable plate for the graft site, as well as a cutting guide for the graft procedure. A split-calvarial bone graft was used to reconstruct the central bony defect in the anterior table of the frontal sinus. Virtual surgical planning sessions were initiated with KLS Martin biomedical engineers to design a graft. Design cutting guides were created for frontal craniotomy, and an interlocking cutting guide was created for the split calvarial bone graft. The graft was harvested from the non-dominant right parietal hemisphere to best match the curvature of the frontal bone. Post-operatively, the patient has not had any complications to date. This procedure proves to be a valuable consideration for the surgical treatment of pediatric osteomas.

Bakgrund: Inom slutenvården i Sverige varje år utförs cirka 800 000 operationer där patienter skall positioneras inför operationen på ett säkert sätt för att förebygga vårdskador. Den perioperativa vården utgör därmed en central del. Ett operationsteam som arbetar tillsammans och använder sina unika kunskaper ihop stärker patientsäkerheten. Delaktighet är centralt i allt vårdande men det saknas kunskap om hur detta synliggörs i patientens positionering på operationsbordet. Syfte: Syftet med denna studie var att undersöka hur operationsteamet gör patienten delaktig i sin positionering på operationsbordet. Metod: En kvalitativ icke-deltagande observationsstudie genomfördes på två sjukhus i sydvästra Sverige. Insamlad data analyserades med hjälp av Graneheim och Lundmans beskrivning av en kvalitativ innehållsanalys. Resultat: Operationsteamet gör patienten delaktig i sin positionering på operationsbordet på olika sätt; genom att guida patienten genom processen, inge trygghet och lugn på operationssalen, ge information, ge bekräftelse och inkludera patienten i teamet. I några fall var patienten inte i fokus och gjordes inte delaktig, därmed exkluderades patienten ur teamet. Slutsats: Operationsteamet är oftast väl rutinerade i hur de skall delaktiggöra patienten i sin positionering på operationsbordet. Att teamet är välfungerande och kan lyssna på och bekräfta patienten samt förmedla lugn och trygghet, bidrar till ökad delaktighet. / Background: Within Swedish inpatient care around 800000 surgeries are performed each year and where patients are positioned on the operating table in a way that prevents injuries. An operating team that works and uses their unique skills together can prevent lifethreatening complications. Patient participation is central to all care but there is a lack of knowledge about how this is made visible in the patient's positioning on the operating table.  Aim: Investigate the work of the surgical team to involve the patient in their positioning on the operating table. Method: A qualitative non-participation observational study was conducted in two hospitals in south-western Sweden. Collected data was analyzed using Graneheim and Lundmans description of a qualitative content analysis. Results: The surgical team usually involves the patient in their positioning and this in several different ways; by guiding the patient through the process, offering safety in the operating room, providing information, confirmation and including the patient. In some cases, the patient was not involved and excluded from the team. Conclusion: The operating team is usually very familiar with how they're going to involve the patient in their positioning. A team that is well-functioning listens to and confirm the patient and offer security, contributes to increased participation.

INTRODUCTION: For persons with diabetes, surgery is fraught with complications; of primary concern is postoperative infection. A postoperative infection rate of up to 13% has been noted in patients with diabetes undergoing elective surgical procedures compared with less than 3% in nondiabetic populations. OBJECTIVE: The objective of this study was to provide preliminary evaluation of the efficacy of a novel bioresorbable microfilm matrix (20 µm thick) containing very low amounts of silver (0.16 mg/in²) in preventing surgical site infections when placed at the level of subcutaneous tissue and dermis prior to primary closure in the patient with diabetes undergoing elective surgery. MATERIALS AND METHODS: Twenty-two patients with diabetes undergoing nonemergent or elective foot or ankle surgery and who met at least 1 of the following 6 criteria were included in the study: neuropathy, infection, open wound, history of recurrent infection, nonhealing wound, or peripheral vascular disease. Patients underwent amputation, removal of exostosis, midfoot bone removal, Achilles tendon repair, bunionectomy, or an elevating osteotomy with primary closure of the wound. After hemostasis was obtained and subcutaneous closure achieved, if applicable, the bioresorbable microfilm matrix was applied just deep to the incision at the level of subcutaneous tissue and dermis, and the incision primarily closed. A nonadherent cover dressing was applied over the suture line, and routine follow-up was scheduled for 3 to 5 days later. RESULTS: No patient exhibited signs of infection at initial follow-up, and all adherent patients achieved complete healing during the 3-month follow-up period. Eighteen patients healed at a rate typical for the respective procedure. In 2 patients, time to healing was delayed secondary to weight-bearing dehiscence. Two patients were not included in the results secondary to multiple infractions of nonadherence with the postoperative protocol. CONCLUSIONS: The application of microfilm matrix in surgical incisions at the level of subcutaneous tissue and dermis prior to primary closure is safe for and has the potential to prevent postoperative surgical site infections in at-risk patients with diabetes..

No description available.