In order to improve the minimal access fetal surgery technique the following requirements should be met: existing pediatric and obstetric endoscopic techniques need to be modified, novel fetoscopic instruments should be developed, and also it is necessary to use a multidisciplinary team approach. Several obstacles were met during the development of the technique. The issue of poor visualization in turbid amniotic fluid is one of them was solved via pump driven fluid exchanger, which replaces amniotic fluid with saline in the course of operating, and that exchanged fluid is kept at physiological temperature in order to eliminate fetal hypothermia with fluid exchange. Also lack of fetal monitoring was resolved by inventing the ultrasonographic monitoring and lack of fetal analgesia was set via intramuscular fetal needle puncture with an analgesic. Mobile fetus was fixed by fetal suture fixation techniques and ultrasound directed trocar entry with the knowledge of fetal position.
However, each of these methods come with some advantages and some disadvantages that are discussed in this paragraph. X-ray, one of the commonly used method can be used only in a static manner to analyze residual femoral movement within transfemoral sockets and also residual tibial movement within transtibial sockets. The contact between the residual limb and prosthetic socket can also be studied using X-ray imaging. However, X-ray images cannot be used for volumetric and three dimensional\thinspace(3D) measurements. Using CT, the 3D shape of the residual limb can be reconstructed from a number of two dimensional\thinspace(2D) slices that are taken transversely to the limb's long axis.
Autonomic nerves lie anterior to Denonviliers ' fascia, thus working within fascia propria avoid injury to autonomic pelvic nerves . This study evaluates the short term outcomes of trans anal full thickness procedure for cases of rectosigmoid Hirschsprung 's disease by performing dissection tightly on the rectal wall within the fascia propria to prevent injury of pelvic nerves and other structures and avoid obstructive symptoms associated with other procedures like Soave (muscular cuff) or Duhamel (spur
9. Discussion There are different types of surgical method or techniques that have been developed in past years to achieve fusion and reduction for the deformity of isthmic spondylolisthesis, [52, 53, 59-62] but it is difficult to define the ideal surgical strategy for IS in adults based on the published data . Each procedure has its own advantages and disadvantages; the basic principle of surgical treatment is decompression and stabilization. In various studies, some Surgeon [65, 66, 67] showed that in case of severe spondylolisthesis, it is better to fuse in situ then reduction procedure in the long bone. However, for slipped vertebrae extended at one or two level, usually fusion in situ is performed [65, 66, 68].
The stability can be provided either by putting a splint or cast (in case of a minor fracture) or by surgical intervention in the form of metallic intramedullary nails or screws and plates. The time taken for the bone to heal completely depends upon age and the extent of trauma. Thus, many a time non-unions arise in the bone. It then calls upon further surgical procedures in order to allow treatment of bone defects. Clinically, the most commonly employed procedure is autografting followed by allografting; of which autografts are currently considered as the gold standard.
Midshaft femur fractures with other fractures on the same limb are also contraindicated, as mentioned previously this can twist the bone and result in further injury. Patients with pelvic bone injuries are not allowed to have traction splints applied to them; there is a large amount of blood loss with pelvic fractures and by applying a traction splint there will be movement that will result in more blood loss. It is also very important to assess the patient’s neurovascular before and after splinting the extremity, this is to know if there are any injuries to the nervous within the
Laparoscopic surgery is related to a well known complication named as Trocar-site hernias. Trocar size is the essential measure by which most gynecologic specialists choose to close fascial incisions; traditional practice is closure of 10-mm cuts and non-closure of 5-mm incision . Fascial closure does not avoid incisional hernia advancement . Paramedian area and blunt sort trocars are two figures that have been widely discussed and experienced in general surgery and urologic surgery Level II studies as measures by which fascial closure is not required 10-mm and 12-mm cuts . We would suggest surgeons examine fascial closure in 5-mm incisions where broad, prolonged manipulation happened that may have expanded or broadened the initial imperfection
Therefore, it is important to choose the perfect suture patterns and techniques for different type of tissues. Simple interrupted, horizontal mattress and vertical mattress suture patterns are usually done on the skin. Simple continuous suture can be done on subcutaneous tissue. Fascias are usually sutured with simple continuous, simple interrupted and also vertical mattress. Apart from that, vessels are usually sutured with simple interrupted and simple continuous suture.
Many rigid internal fixation techniques exist for the possible reduction and fixation of the mandibular condyle. Data in the literature has pointed out that single noncompression mini plate has remained to be the most frequently used method of osteosynthesis despite various issues such as screw fracture and plate loosening being associated with it. Using double plates has demonstrated superior stability in the fixation of condylar fractures despite the burden of the cost of an additional plate and longer operating time. No study exists that justifies the clinical usefulness of
Transplantation technique is the same in both techniques. In the FUT technique, a line of mark might appear because hairy area that is taken from donor area is sutured aesthetically. Hair roots are classified as unary, binary and triple roots. It is placed to the hairless area via opening micro channels with local anaesthesia. It is necessary to wait for 6 months to apply the 2nd session.