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Philippe LIVERNEAUX

Centre de Chirurgie Orthopédique et de la Main
Illkirch-Graffenstaden, France
MD
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Konnyaku shirataki model for training in robotic microsurgery anastomosis
The aim of this study was to test the feasibility of a type of Japanese noodle, named ‘shirataki konnyaku’, for microsurgery training in the operating room. Thirteen surgical residents without experience in microsurgery had to perform two microsurgical anastomoses: one in a model of a femoral artery of a rat (control) and one in a model of a konnyaku shirataki. Two quantitative variables (time in minutes and number of stitches to perform the anastomosis) and two qualitative variables (patency and tightness of the anastomosis) were measured. Sixty anastomoses were performed with the control model and 62 anastomoses with the konnyaku model. The time of the anastomosis was significantly higher in the control group. The number of stitches was similar in both groups. The patency of the anastomosis was significantly lower in the control group. The tightness (no leak) of the anastomosis was significantly higher in the control group. The ‘konnyaku shirataki’ model could improve the teaching of microsurgery due to its availability, low cost, and structural similarity to the animal model.
Surgical intervention
4 years ago
381 views
6 likes
0 comments
01:45
Konnyaku shirataki model for training in robotic microsurgery anastomosis
The aim of this study was to test the feasibility of a type of Japanese noodle, named ‘shirataki konnyaku’, for microsurgery training in the operating room. Thirteen surgical residents without experience in microsurgery had to perform two microsurgical anastomoses: one in a model of a femoral artery of a rat (control) and one in a model of a konnyaku shirataki. Two quantitative variables (time in minutes and number of stitches to perform the anastomosis) and two qualitative variables (patency and tightness of the anastomosis) were measured. Sixty anastomoses were performed with the control model and 62 anastomoses with the konnyaku model. The time of the anastomosis was significantly higher in the control group. The number of stitches was similar in both groups. The patency of the anastomosis was significantly lower in the control group. The tightness (no leak) of the anastomosis was significantly higher in the control group. The ‘konnyaku shirataki’ model could improve the teaching of microsurgery due to its availability, low cost, and structural similarity to the animal model.
Nerve tumor excision with robots
Chronic peripheral nerve lesion surgery should not only limit recurrence after excision, but it could also limit sensory and motor sequelae. The aim of this work was to study the interest of telemicrosurgery to improve this result.
Our series included 7 patients with peripheral nerve neuroma and tumors including two cases of hereditary neurofibromatosis. A da Vinci S® robot with microsurgical instruments was used for intraneural dissection. One case was performed using a minimally invasive approach.
At the last follow-up, pain ranged from 6/10 preoperatively to 3/10 postoperatively. The sensory deficit was stable except in 2 patients whose sensory function was improved. No recurrence was noted.
Telemicrosurgery seems to have two interests in the treatment of chronic peripheral nerve lesions: it reduces the size of incisions and increases surgery accuracy. These preliminary results suggest that surgical robots could play an essential role in microsurgery.
Lecture
5 years ago
91 views
1 like
0 comments
10:17
Nerve tumor excision with robots
Chronic peripheral nerve lesion surgery should not only limit recurrence after excision, but it could also limit sensory and motor sequelae. The aim of this work was to study the interest of telemicrosurgery to improve this result.
Our series included 7 patients with peripheral nerve neuroma and tumors including two cases of hereditary neurofibromatosis. A da Vinci S® robot with microsurgical instruments was used for intraneural dissection. One case was performed using a minimally invasive approach.
At the last follow-up, pain ranged from 6/10 preoperatively to 3/10 postoperatively. The sensory deficit was stable except in 2 patients whose sensory function was improved. No recurrence was noted.
Telemicrosurgery seems to have two interests in the treatment of chronic peripheral nerve lesions: it reduces the size of incisions and increases surgery accuracy. These preliminary results suggest that surgical robots could play an essential role in microsurgery.
Endoscopic microsurgery: a new concept
In this authoritative lecture, Dr. Philippe Liverneaux focuses on endoscopic microsurgery. Conventional microsurgery requires large incisions and extensive dissections while it is performed in a small operating field. In this context, the concept of endoscopic microsurgery appears to be a logical way to be put to the test.
We rely on four years of practical experience using the Da Vinci™ robot at the European Institute of Telesurgery in Strasbourg, France. To-date, 40 patients have been operated on by our Hand Surgery and Peripheral Nerve Department.
Endoscopic Microsurgery combines the properties of microsurgery, endoscopic surgery, and telesurgery. Not only does it allow to magnify the vision of the operating field, but it also allows to multiply the operator's hand movements, and all the more so by means of minimally invasive approaches. Its evolution necessitates the development of a dedicated robot and specific instrumentation capable of handling such procedures.
Lecture
7 years ago
444 views
2 likes
0 comments
19:34
Endoscopic microsurgery: a new concept
In this authoritative lecture, Dr. Philippe Liverneaux focuses on endoscopic microsurgery. Conventional microsurgery requires large incisions and extensive dissections while it is performed in a small operating field. In this context, the concept of endoscopic microsurgery appears to be a logical way to be put to the test.
We rely on four years of practical experience using the Da Vinci™ robot at the European Institute of Telesurgery in Strasbourg, France. To-date, 40 patients have been operated on by our Hand Surgery and Peripheral Nerve Department.
Endoscopic Microsurgery combines the properties of microsurgery, endoscopic surgery, and telesurgery. Not only does it allow to magnify the vision of the operating field, but it also allows to multiply the operator's hand movements, and all the more so by means of minimally invasive approaches. Its evolution necessitates the development of a dedicated robot and specific instrumentation capable of handling such procedures.
Arthroscopic interposition arthroplasty: preliminary results
Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.
Lecture
7 years ago
269 views
3 likes
0 comments
11:20
Arthroscopic interposition arthroplasty: preliminary results
Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.
Arthroscopic removal of volar ganglia
Arthroscopic removal of volar ganglia is a reasonable and safe approach, which requires understanding of specific technical gestures. The main indication being esthetic, the use of wrist arthroscopy is perfect. This video will show you how to perform this reliable procedure in a safe way. This young woman has a small volar ganglion, causing pain by creating pressure difference in the radiocarpal joint. Removing this kind of volar ganglion can be satisfied only by the radiocarpal joint. We will use a 3-4 portal for the scope and a 1-2 instrumental portal. Locating the origin of the ganglion can be assisted by external manipulation. It is usually located between the scapho radio-capitate ligaments and long radiolunate ligaments. Ganglion removal is carried out from the inside of the joint using a shaver. The operation may be considered completed when the anterior capsulectomy is performed and, possibly when we see the tendons. It is not necessary to close the portals, a simple dressing will be applied, and the patient may be able to totally use her hand and wrist the same day.
Surgical intervention
9 years ago
1002 views
21 likes
0 comments
07:44
Arthroscopic removal of volar ganglia
Arthroscopic removal of volar ganglia is a reasonable and safe approach, which requires understanding of specific technical gestures. The main indication being esthetic, the use of wrist arthroscopy is perfect. This video will show you how to perform this reliable procedure in a safe way. This young woman has a small volar ganglion, causing pain by creating pressure difference in the radiocarpal joint. Removing this kind of volar ganglion can be satisfied only by the radiocarpal joint. We will use a 3-4 portal for the scope and a 1-2 instrumental portal. Locating the origin of the ganglion can be assisted by external manipulation. It is usually located between the scapho radio-capitate ligaments and long radiolunate ligaments. Ganglion removal is carried out from the inside of the joint using a shaver. The operation may be considered completed when the anterior capsulectomy is performed and, possibly when we see the tendons. It is not necessary to close the portals, a simple dressing will be applied, and the patient may be able to totally use her hand and wrist the same day.
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
Surgical intervention
9 years ago
1169 views
30 likes
0 comments
21:38
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.