Recent advances in surgical technology

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Recent advances in surgical technology

  1. 1. RECENT ADVANCES IN SURGICAL TECHNOLOGY
  2. 2. INTRODUCTION <ul><li>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. </li></ul>
  3. 3. MAGNIFICATION SYSTEMS
  4. 4. <ul><li>A variety of simple & complex </li></ul><ul><li>magnification system are available ranging from simple loupes to prism telescopic loupes & surgical microscopes. </li></ul><ul><li>Each system has its advantages & limitations. </li></ul><ul><li>Magnification system improves the accuracy of clinical & diagnostic skills. </li></ul>
  5. 5. MAGNIFYING LOUPES
  6. 6. <ul><li>STRUCTURE:- </li></ul><ul><li>Two monocular telescopes with side by side lenses converged to focus on the operative field. </li></ul><ul><li>Magnified image has sterioscopic properties. </li></ul><ul><li>A convergent lens optical system also called a KEPLERIAN optical system. </li></ul>
  7. 7. Disadvantages <ul><li>Clinician’s eyes must converge to view the operative field </li></ul><ul><li>May result in </li></ul><ul><li>eye strain </li></ul><ul><li>fatigue </li></ul><ul><li>pathological vision changes </li></ul>
  8. 8. TYPES <ul><li>SIMPLE COMPOUND PRISM </li></ul><ul><li>TELESCOPIC </li></ul>
  9. 9. a)SIMPLE LOUPES <ul><li>STRUCTURE:- </li></ul><ul><li>Consist of a pair of single meniscus lenses. </li></ul><ul><li>They are primitive magnifiers with limited capabilities. </li></ul><ul><li>Each lens is limited to just two refracting surfaces. </li></ul>
  10. 11. Limitation <ul><li>Only increasing there lens diameter or thickness can increase their magnification. </li></ul><ul><li>Highly affected by spherical & chromatic aberration. </li></ul><ul><li>Distort the shape & color of object being viewed. </li></ul>
  11. 12. b)COMPOUND LOUPES <ul><li>STRUCTURE:- </li></ul><ul><li>Multielement lenses with intervening air space. </li></ul><ul><li>Gain additional refracting surfaces </li></ul>
  12. 14. Advantages <ul><li>Allow increase magnification with more favourable working distance & depth of field. </li></ul><ul><li>Can be adjusted to some clinical needs without excessive increase in size or weight . </li></ul><ul><li>Can be achromatic. </li></ul><ul><li>Specific density of each lens counteracts the chromatic aberration </li></ul><ul><li>Produces color correct image. </li></ul>
  13. 15. Disadvantage <ul><li>They become optically inefficient at magnification above 3.0 diameter. </li></ul>
  14. 16. C) Prism-Telescopic Loupes <ul><li>Structure : - </li></ul><ul><li>Lengthens the light path through a series of switchback mirror reflection within the lens elements. </li></ul><ul><li>This arrangement folds light so that the barrel of the telescopic loupes can be shortened. </li></ul>
  15. 18. Advantages <ul><li>Produces better magnification. </li></ul><ul><li>Wider depth of field. </li></ul><ul><li>Longer working distance. </li></ul><ul><li>Larger field of view. </li></ul>
  16. 19. <ul><li>Recent innovation : - </li></ul><ul><li>Coaxial fiber-optic lighting is incorporated in the lens elements. </li></ul><ul><li>Improve illumination </li></ul>
  17. 21. Magnification Range Of Surgical Loupes <ul><li>Limited range of magnification from 1.5x to 10x. </li></ul><ul><li>Less than 2.5x inadequate for visual </li></ul><ul><li>acuity necessary. </li></ul><ul><li>More that 4.5x provide adequate </li></ul><ul><li>combination of magnification, </li></ul><ul><li>field of view & depth of focus. </li></ul>
  18. 22. SURGICAL OPERATING MICROSCOPE
  19. 23. Structure <ul><li>Have binocular eyepieces joined by offsetting prisms with parallel optical axis. </li></ul><ul><li>Allow viewing of operating field without eye convergence. </li></ul><ul><li>Permit relaxed viewing of operating field. </li></ul><ul><li>No eye strain or fatigue. </li></ul>
  20. 24. <ul><li>Incorporate fully coated optics with achromatic lenses. </li></ul><ul><li>Provide highest optical resolution with the most efficient illuminations. </li></ul>
  21. 26. ADVANTAGES <ul><li>Provide better magnification. </li></ul><ul><li>Better optical performance. </li></ul><ul><li>Durable. </li></ul><ul><li>Versatile. </li></ul><ul><li>Allow dentist to easily change working magnification. </li></ul><ul><li>Some microscopes incorporate electronic foot controlled focus & magnification for further convinience. </li></ul>
  22. 27. <ul><li>8.The surgeon can view, perfectly the deepest reaches of the oral cavity, including into subgingival pockets & angular bony defect. </li></ul><ul><li>9.Definitive visualization of root surface deposits & irregularities is possible. </li></ul>7. Have a rotating variable magnification.
  23. 28. <ul><li>Periodontal surgeon must establish adequate working distance between the surgical field & the microscope objective lens. </li></ul><ul><li>Consist of coaxial fiber-optic illumination </li></ul><ul><li>position the light source exactly parallel to the microscope’s optical axis. </li></ul><ul><li>with coaxial lighting no shadow is produced </li></ul>
  24. 29. Beam splitter camera attachment <ul><li>35mm slides can easily be produced. </li></ul><ul><li>With a foot-operated shutter control, the surgeon can compose the photographic field as the procedure unfolds without interrupting the surgery. </li></ul><ul><li>Excellent video documentation is also available. </li></ul><ul><li>High resolution cameras with video & slide printers, high resolution digital video cameras are currently replacing 35mm camera. </li></ul>
  25. 31. PERIODONTAL MICROSURGERY
  26. 32. Definition <ul><li>Microsurgery is defined as a refinement in operative technique by which visual acuity is enhanced through the use of surgical operating microscope </li></ul><ul><li>It is a methodology, through which surgical techniques are modified to accommodate the improved motor coordination made possible through magnification. </li></ul>
  27. 33. ROOT PREPRATION <ul><li>Studies demonstrate that root debridement, performed without magnification, was incomplete. </li></ul><ul><li>Magnification enhanced vision may permits more definitive root debridement. </li></ul><ul><li>Among the primary aim of periodontal surgery is visual access to the root surface for plaque & calculus removal & for removing pathologically altered tooth structure. </li></ul>
  28. 34. <ul><li>Magnification greatly improves the </li></ul><ul><li>surgeon’s ability to create a clean, smooth root surface. </li></ul><ul><li>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. </li></ul><ul><li>This encourages primary wound healing & enhances periodontal regeneration. </li></ul>
  29. 35. SURGERY UNDER MAGNIFICATION
  30. 36. <ul><li>Periodontist have always attempted to treat the surgical site atraumatically & to achieve primary wound closure. </li></ul><ul><li>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 </li></ul>
  31. 37. MICROSURGICAL INSTRUMENTS
  32. 38. <ul><li>Microsurgery entails the use of specially constructed microsurgical instruments designed specially to minimize trauma. </li></ul><ul><li>An important characteristic of microsurgical instruments is their ability to create clean incision that prepare wounds for healing by primary intention. </li></ul><ul><li>Microsurgical incision are established at a 90 degree angle to the surface using opthalmic microsurgical scalpels. </li></ul>
  33. 39. <ul><li>Microscopy permits easy identification </li></ul><ul><li>of ragged wound edges for trimming & freshening. </li></ul><ul><li>For primary wound closure, micro-sutures in the range of 6-9 are needed to approximate the wound edges. </li></ul><ul><li>Microsurgical wound apposition minimizes gapes or voids at the wound edges. </li></ul><ul><li>Encourages rapid healing with less postoperative inflammation & with less pain. </li></ul>
  34. 43. <ul><li>Studies shows that motor coordination is greatly improved when surgeons use microsugical instruments specifically designed to employ a precision grip of the hand </li></ul><ul><li>Microsurgical instruments are circular in cross section to permit precise rotational movements. </li></ul>
  35. 44. <ul><li>They are made up of titanium because of its strength, lightness & non-magnetizing characteristics. </li></ul><ul><li>They reduces unwanted hand movements results in more precise surgeries & greatly reduces surgical fatigue & development of spinal & occupational pathology. </li></ul>
  36. 45. SUMMARY <ul><li>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. </li></ul>

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