Recent advances in surgical technologyPresentation Transcript
RECENT ADVANCES IN SURGICAL TECHNOLOGY
It is a part of broader trend in medicine & dentistry toward the application of minimally invasive technique for procedures that previously required extensive surgical incision.
A variety of simple & complex
magnification system are available ranging from simple loupes to prism telescopic loupes & surgical microscopes.
Each system has its advantages & limitations.
Magnification system improves the accuracy of clinical & diagnostic skills.
Two monocular telescopes with side by side lenses converged to focus on the operative field.
Magnified image has sterioscopic properties.
A convergent lens optical system also called a KEPLERIAN optical system.
Clinician’s eyes must converge to view the operative field
May result in
pathological vision changes
SIMPLE COMPOUND PRISM
Consist of a pair of single meniscus lenses.
They are primitive magnifiers with limited capabilities.
Each lens is limited to just two refracting surfaces.
Only increasing there lens diameter or thickness can increase their magnification.
Highly affected by spherical & chromatic aberration.
Distort the shape & color of object being viewed.
Multielement lenses with intervening air space.
Gain additional refracting surfaces
Allow increase magnification with more favourable working distance & depth of field.
Can be adjusted to some clinical needs without excessive increase in size or weight .
Can be achromatic.
Specific density of each lens counteracts the chromatic aberration
Produces color correct image.
They become optically inefficient at magnification above 3.0 diameter.
C) Prism-Telescopic Loupes
Structure : -
Lengthens the light path through a series of switchback mirror reflection within the lens elements.
This arrangement folds light so that the barrel of the telescopic loupes can be shortened.
Produces better magnification.
Wider depth of field.
Longer working distance.
Larger field of view.
Recent innovation : -
Coaxial fiber-optic lighting is incorporated in the lens elements.
Magnification Range Of Surgical Loupes
Limited range of magnification from 1.5x to 10x.
Less than 2.5x inadequate for visual
More that 4.5x provide adequate
combination of magnification,
field of view & depth of focus.
SURGICAL OPERATING MICROSCOPE
Have binocular eyepieces joined by offsetting prisms with parallel optical axis.
Allow viewing of operating field without eye convergence.
Permit relaxed viewing of operating field.
No eye strain or fatigue.
Incorporate fully coated optics with achromatic lenses.
Provide highest optical resolution with the most efficient illuminations.
Provide better magnification.
Better optical performance.
Allow dentist to easily change working magnification.
Some microscopes incorporate electronic foot controlled focus & magnification for further convinience.
8.The surgeon can view, perfectly the deepest reaches of the oral cavity, including into subgingival pockets & angular bony defect.
9.Definitive visualization of root surface deposits & irregularities is possible.
7. Have a rotating variable magnification.
Periodontal surgeon must establish adequate working distance between the surgical field & the microscope objective lens.
Consist of coaxial fiber-optic illumination
position the light source exactly parallel to the microscope’s optical axis.
with coaxial lighting no shadow is produced
Beam splitter camera attachment
35mm slides can easily be produced.
With a foot-operated shutter control, the surgeon can compose the photographic field as the procedure unfolds without interrupting the surgery.
Excellent video documentation is also available.
High resolution cameras with video & slide printers, high resolution digital video cameras are currently replacing 35mm camera.
Microsurgery is defined as a refinement in operative technique by which visual acuity is enhanced through the use of surgical operating microscope
It is a methodology, through which surgical techniques are modified to accommodate the improved motor coordination made possible through magnification.
Studies demonstrate that root debridement, performed without magnification, was incomplete.
Magnification enhanced vision may permits more definitive root debridement.
Among the primary aim of periodontal surgery is visual access to the root surface for plaque & calculus removal & for removing pathologically altered tooth structure.
Magnification greatly improves the
surgeon’s ability to create a clean, smooth root surface.
Magnification permits preparation of both hard & soft tissue wound surfaces so they may joined together according to the commonly held microsurgical principle of butt-joint wound preparation.
This encourages primary wound healing & enhances periodontal regeneration.
SURGERY UNDER MAGNIFICATION
Periodontist have always attempted to treat the surgical site atraumatically & to achieve primary wound closure.
Periodontal microsurgery is the natural transition from conventional surgical principles to a surgical ethic in which the microscope is employed to permit more accurate & atraumatic handling tissues to enhance wound healing
Microsurgery entails the use of specially constructed microsurgical instruments designed specially to minimize trauma.
An important characteristic of microsurgical instruments is their ability to create clean incision that prepare wounds for healing by primary intention.
Microsurgical incision are established at a 90 degree angle to the surface using opthalmic microsurgical scalpels.
Microscopy permits easy identification
of ragged wound edges for trimming & freshening.
For primary wound closure, micro-sutures in the range of 6-9 are needed to approximate the wound edges.
Microsurgical wound apposition minimizes gapes or voids at the wound edges.
Encourages rapid healing with less postoperative inflammation & with less pain.
Studies shows that motor coordination is greatly improved when surgeons use microsugical instruments specifically designed to employ a precision grip of the hand
Microsurgical instruments are circular in cross section to permit precise rotational movements.
They are made up of titanium because of its strength, lightness & non-magnetizing characteristics.
They reduces unwanted hand movements results in more precise surgeries & greatly reduces surgical fatigue & development of spinal & occupational pathology.
The microsurgery offers new possibilities for periodontal surgery can improve therapeutic result for a variety of procedures & gives benefits of improved cosmetics, rapid healing, minimal discomfort & enhanced pt. acceptance.