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Abstract The number of ambulatory surgical procedures is increasing throughout the world. This is partly due to the development of a number of new anaesthetic, analgesic and adjuvant drugs, each with more rapid onset and shorter duration of action, over the past two decades. An interest in the issues discussed in this thesis arose out a desire to improve the quality of anaesthesia for patients who undergo day-case surgery. A second aim was to compare the different anaesthetic methods in terms of recovery from anaesthesia and costs. A total of 233 patients undergoing day-case knee arthroscopy under either 2% or 5% lidocaine spinal anaesthesia or general anaesthesia with desflurane, isoflurane, propofol or sevoflurane were investigated in two prospective, randomised clinical trials. The overall aims were to find the most suitable, satisfactory and economically feasible method for adult ambulatory knee arthroscopy and to assess the factors that affect the immediate postoperative period and the one-week recovery profile at home. The patients were highly satisfied with all the methods of anaesthesia. There was a slight tendency in favour of general anaesthesia compared to spinal anaesthesia. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively and continued to be low during the first postoperative week. After short-acting general anaesthesia with desflurane, isoflurane and propofol, home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Home readiness was significantly delayed after 2% lidocaine spinal anaesthesia compared to sevoflurane inhalation anaesthesia. General anaesthesia with isoflurane was cheaper than the other general anaesthetics, i.e. desflurane, sevoflurane, propofol, or 2% and 5% lidocaine spinal anaesthesias. Propofol anaesthesia was the most expensive. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia. In busy ambulatory surgery units, remarkable savings may be achieved by using short-acting general anaesthetics, i.e. desflurane and isoflurane, instead of propofol or sevoflurane general anaesthesias or lidocaine spinal anaesthesia. This is due to the lower costs of desflurane and isoflurane compared to sevoflurane and propofol and the shorter time needed for postoperative care compared to spinal anaesthesia.

To alleviate the poor ergonomics which surgeons suffer during knee arthroscopy, a semi-robotic device with braking mechanism is created for intraoperative assistance. A slitted ball joint assembly is developed to transmit the clamping force to the arthroscope inside. Ball deformation and stress at various angles to the vertical and clamping forces is recorded through Abaqus Finite Element Analysis (FEA). Contact forces between the scope and inner surfaces of the ball is also computed in FEA at different clamping forces. The von Mises stress occurring in the ball joint is under the yield stress limit for polyethylene, and there is noticeable force preventing the scope from sliding along the ball through-hole under clamping. A prototype of this device is constructed for proof-of-concept.

The paper presents the development of instrumentaria designed to solve ACL lesions using hamstrings (tendons of semitendinosus and m. gracilis - ST / G). The work itself took place in two phases. Part of the first phase was the development of its own instrumentation, including the implant designed to fix hamstrings tendons. The inherent part of the development was the performance of both mechanical and functional tests. The most tested element of the instrumentation was the screw with eye. In the course of its development, mechanical tests of tensile strength were carried out on the individual variants of the solution, and then the rapture of the screw with the eye from animal bone - simulating the function of the product in a real environment. Part of this was the development of methodology and work with new instrumentation. Clinical testing was performed in the second stage and the results of the operations are part of the work. The self-developed ACL lesion reconstruction toolkit is designed to use a graft made up of four strands of the above tendons. In the experimental part of the instrumentation development, the suitability of the implant for clinical use has been demonstrated. The newly developed instrumentation for ACL reconstruction, using the test implant for fixation of the hamstrings...