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Bernardo MARTINEZ

Toledo Hospital
Toledo, Ohio, United States
MD, FACS
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Robotic technology in wound healing osteomyelitis
Introduction:
We initiated the use of robotic instrumentation in the surgical management of complex, recurrent non-healing wounds due to osteomyelitis in July 2012. The primary objective is to demonstrate the benefit of the visual superiority and more precise tissue dissection offered by robotic technology.

Material and methods:
After obtaining approval for the use of the da Vinci® robotic surgical system (Intuitive Surgical®) as an “exoscopic” approach at our institution, three patients were enrolled in the protocol wound debridement/osteomyelitis/da Vinci®.
We will be presenting the clinical manifestations and imaging diagnosis of osteomyelitis, as well as outlining the surgical procedure and the use of the robotic system for soft tissue and bone debridement. The complimentary application of bioengineering tissue enhancement material was used in one patient (Cryopreserved amniotic membrane Amniox®), and in two patients (Apligraf Organogenesis, Inc). Comprehensive postoperative wound management will be discussed.

Results:
Two patients had completely healed wounds at 130 and 230 days respectively, without functional joint deficit. Although the third patient had only 3 weeks of follow-up, they appear to be progressing as expected.

Conclusions:
The basic capability of robotic technology (visual and manual control) appears to facilitate the surgical management of osteomyelitis, particularly in restricted anatomical spaces and in proximity to joints. We propose further clinical research and outcome healing measurements with this subgroup of patients that might otherwise require amputation.
Lecture
5 years ago
92 views
3 likes
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09:44
Robotic technology in wound healing osteomyelitis
Introduction:
We initiated the use of robotic instrumentation in the surgical management of complex, recurrent non-healing wounds due to osteomyelitis in July 2012. The primary objective is to demonstrate the benefit of the visual superiority and more precise tissue dissection offered by robotic technology.

Material and methods:
After obtaining approval for the use of the da Vinci® robotic surgical system (Intuitive Surgical®) as an “exoscopic” approach at our institution, three patients were enrolled in the protocol wound debridement/osteomyelitis/da Vinci®.
We will be presenting the clinical manifestations and imaging diagnosis of osteomyelitis, as well as outlining the surgical procedure and the use of the robotic system for soft tissue and bone debridement. The complimentary application of bioengineering tissue enhancement material was used in one patient (Cryopreserved amniotic membrane Amniox®), and in two patients (Apligraf Organogenesis, Inc). Comprehensive postoperative wound management will be discussed.

Results:
Two patients had completely healed wounds at 130 and 230 days respectively, without functional joint deficit. Although the third patient had only 3 weeks of follow-up, they appear to be progressing as expected.

Conclusions:
The basic capability of robotic technology (visual and manual control) appears to facilitate the surgical management of osteomyelitis, particularly in restricted anatomical spaces and in proximity to joints. We propose further clinical research and outcome healing measurements with this subgroup of patients that might otherwise require amputation.
Transaxillary first rib resection from an endoscopic concept to robotic technology, 30 years of experience
Introduction:
Our interest in minimally invasive vascular surgery dates back to 1982. We designed our endoscope, attached to a micro-video camera, making the transaxillary first rib and cervical band resection safer for the surgical treatment of disabling thoracic outlet syndrome. Over the following two decades, we evolved with the rapid technological development of minimally invasive surgery.

Material and methods:
644 total surgical procedures were performed between 1983 and 2013, including various stages. Video presentation of the “final product” in evolution during the past 10 years using the da Vinci® robotic system will be shown.

Results:
There were no mortalities, no permanent nerve, artery, or vein damage. The following could be noted: 8% complications, 4% respiratory, 3% temporary neurological dysfunctions, 0.8% infection, 0.4% transient renal insufficiency. Conversion rate was 1.1%, scar tissue formation of 0.4%, and length of stay: 3.3 days.

Conclusions:
The endoscopic transaxillary approach has helped us to understand the pathogenesis of the cervical bands frequently present in thoracic outlet syndrome. The procedure has evolved over the last 3 decades and the da Vinci® robotic system definitely offers great advantages, improving the surgical procedure and clinical outcome.
Lecture
5 years ago
336 views
7 likes
0 comments
14:10
Transaxillary first rib resection from an endoscopic concept to robotic technology, 30 years of experience
Introduction:
Our interest in minimally invasive vascular surgery dates back to 1982. We designed our endoscope, attached to a micro-video camera, making the transaxillary first rib and cervical band resection safer for the surgical treatment of disabling thoracic outlet syndrome. Over the following two decades, we evolved with the rapid technological development of minimally invasive surgery.

Material and methods:
644 total surgical procedures were performed between 1983 and 2013, including various stages. Video presentation of the “final product” in evolution during the past 10 years using the da Vinci® robotic system will be shown.

Results:
There were no mortalities, no permanent nerve, artery, or vein damage. The following could be noted: 8% complications, 4% respiratory, 3% temporary neurological dysfunctions, 0.8% infection, 0.4% transient renal insufficiency. Conversion rate was 1.1%, scar tissue formation of 0.4%, and length of stay: 3.3 days.

Conclusions:
The endoscopic transaxillary approach has helped us to understand the pathogenesis of the cervical bands frequently present in thoracic outlet syndrome. The procedure has evolved over the last 3 decades and the da Vinci® robotic system definitely offers great advantages, improving the surgical procedure and clinical outcome.