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Yasushi Takagi - One of the best experts on this subject based on the ideXlab platform.
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efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a Hybrid Operating Room
Journal of Neurosurgery, 2020Co-Authors: Kenji Shimada, Tadashi Yamaguchi, Takeshi Miyamoto, Shu Sogabe, Masaaki Korai, Toshiyuki Okazaki, Yasuhisa Kanematsu, Junichiro Satomi, Shinji Nagahiro, Yasushi TakagiAbstract:Objective Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs. Methods Intraarterial ICG videoangiography was performed in 13 patients with cerebral AVMs. Routine intraoperative digital subtraction angiography at the authors' institution is performed in a Hybrid Operating Room during AVM surgery and includes the added step of injecting ICG to the contrast medium that is administered through a catheter. Results Predissection studies were able to visualize the feeder in 12 of 13 cases. The nidus was visualized in 12 of 13 cases, while the drainer was visualized in all cases. After total dissection of the nidus, there was no ICG filling in the drainers found in any of the cases. Washout of the ICG took 4.4 ± 1.3 seconds in the feeders, 9.2 ± 3.5 seconds in the drainers, and 20.9 ± 3.4 seconds in all of the vessels. Nidus flow reduction was confirmed during dissection in 9 of 9 cases. Flow reduction was easy to recognize due to each span being very short. Color-encoded visualization and objective data obtained by Flow 800 analysis reinforced these findings. Conclusions The results showed that intraarterial ICG videoangiography was more useful than intravenous ICG videoangiography in cerebral AVM surgery. This was especially effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.
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Efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a Hybrid Operating Room.
Journal of Neurosurgery, 2020Co-Authors: Kenji Shimada, Tadashi Yamaguchi, Takeshi Miyamoto, Shu Sogabe, Masaaki Korai, Toshiyuki Okazaki, Yasuhisa Kanematsu, Junichiro Satomi, Shinji Nagahiro, Yasushi TakagiAbstract:OBJECTIVE: Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs. METHODS: Intraarterial ICG videoangiography was performed in 13 patients with cerebral AVMs. Routine intraoperative digital subtraction angiography at the authors' institution is performed in a Hybrid Operating Room during AVM surgery and includes the added step of injecting ICG to the contrast medium that is administered through a catheter. RESULTS: Predissection studies were able to visualize the feeder in 12 of 13 cases. The nidus was visualized in 12 of 13 cases, while the drainer was visualized in all cases. After total dissection of the nidus, there was no ICG filling in the drainers found in any of the cases. Washout of the ICG took 4.4 ± 1.3 seconds in the feeders, 9.2 ± 3.5 seconds in the drainers, and 20.9 ± 3.4 seconds in all of the vessels. Nidus flow reduction was confirmed during dissection in 9 of 9 cases. Flow reduction was easy to recognize due to each span being very short. Color-encoded visualization and objective data obtained by Flow 800 analysis reinforced these findings. CONCLUSIONS: The results showed that intraarterial ICG videoangiography was more useful than intravenous ICG videoangiography in cerebral AVM surgery. This was especially effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.
Jean Philippe Verhoye - One of the best experts on this subject based on the ideXlab platform.
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transcatheter aortic valve replacement in the catheterization laboratory versus Hybrid Operating Room insights from the france tavi registry
Jacc-cardiovascular Interventions, 2018Co-Authors: Marco Spaziano, Thierry Lefevre, Mauro Romano, Helene Eltchaninoff, Pascal Leprince, Pascal Motreff, Bernard Iung, Eric Van Belle, R Koning, Jean Philippe VerhoyeAbstract:Abstract Objectives This study sought to compare outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) in a catheterization laboratory (cath lab) to those undergoing TAVR in a Hybrid Operating Room (OR). Background TAVR can be performed in a cath lab or in a Hybrid OR. Comparisons between these locations are scarce. Methods All TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. The primary endpoint of this study was all-cause mortality at 1 year. Secondary endpoints consisted of 30-day complications and 3-year mortality. All analyses were adjusted for baseline and procedural characteristics. Results A total of 12,121 patients were included in this study, 62% of which underwent TAVR in a cath lab versus 38% in a Hybrid OR. Mean age was 82.9 ± 7.2 years, 48.9% of patients were men, and mean Logistic EuroScore was 17.9% ± 12.3%. Both procedure locations showed similar, below 2% rates of intraprocedural complications. After adjusting for baseline and procedural characteristics, major bleeding and infections were significantly higher in the Hybrid OR group (bleeding, 6.3% vs. 4.8%; infection, 6.1% vs. 3.5%; p Conclusions Midterm mortality after TAVR was similar between the cath lab and the Hybrid OR. These findings support the performance of TAVR in either location, which has important implications on health care organization and costs.
Kenji Shimada - One of the best experts on this subject based on the ideXlab platform.
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efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a Hybrid Operating Room
Journal of Neurosurgery, 2020Co-Authors: Kenji Shimada, Tadashi Yamaguchi, Takeshi Miyamoto, Shu Sogabe, Masaaki Korai, Toshiyuki Okazaki, Yasuhisa Kanematsu, Junichiro Satomi, Shinji Nagahiro, Yasushi TakagiAbstract:Objective Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs. Methods Intraarterial ICG videoangiography was performed in 13 patients with cerebral AVMs. Routine intraoperative digital subtraction angiography at the authors' institution is performed in a Hybrid Operating Room during AVM surgery and includes the added step of injecting ICG to the contrast medium that is administered through a catheter. Results Predissection studies were able to visualize the feeder in 12 of 13 cases. The nidus was visualized in 12 of 13 cases, while the drainer was visualized in all cases. After total dissection of the nidus, there was no ICG filling in the drainers found in any of the cases. Washout of the ICG took 4.4 ± 1.3 seconds in the feeders, 9.2 ± 3.5 seconds in the drainers, and 20.9 ± 3.4 seconds in all of the vessels. Nidus flow reduction was confirmed during dissection in 9 of 9 cases. Flow reduction was easy to recognize due to each span being very short. Color-encoded visualization and objective data obtained by Flow 800 analysis reinforced these findings. Conclusions The results showed that intraarterial ICG videoangiography was more useful than intravenous ICG videoangiography in cerebral AVM surgery. This was especially effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.
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Efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a Hybrid Operating Room.
Journal of Neurosurgery, 2020Co-Authors: Kenji Shimada, Tadashi Yamaguchi, Takeshi Miyamoto, Shu Sogabe, Masaaki Korai, Toshiyuki Okazaki, Yasuhisa Kanematsu, Junichiro Satomi, Shinji Nagahiro, Yasushi TakagiAbstract:OBJECTIVE: Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs. METHODS: Intraarterial ICG videoangiography was performed in 13 patients with cerebral AVMs. Routine intraoperative digital subtraction angiography at the authors' institution is performed in a Hybrid Operating Room during AVM surgery and includes the added step of injecting ICG to the contrast medium that is administered through a catheter. RESULTS: Predissection studies were able to visualize the feeder in 12 of 13 cases. The nidus was visualized in 12 of 13 cases, while the drainer was visualized in all cases. After total dissection of the nidus, there was no ICG filling in the drainers found in any of the cases. Washout of the ICG took 4.4 ± 1.3 seconds in the feeders, 9.2 ± 3.5 seconds in the drainers, and 20.9 ± 3.4 seconds in all of the vessels. Nidus flow reduction was confirmed during dissection in 9 of 9 cases. Flow reduction was easy to recognize due to each span being very short. Color-encoded visualization and objective data obtained by Flow 800 analysis reinforced these findings. CONCLUSIONS: The results showed that intraarterial ICG videoangiography was more useful than intravenous ICG videoangiography in cerebral AVM surgery. This was especially effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.
Peter H Richter - One of the best experts on this subject based on the ideXlab platform.
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radiation exposure for the surgical team in a Hybrid Operating Room
Journal of Robotic Surgery, 2019Co-Authors: Konard Schuetze, Florian Gebhard, Alexander Eickhoff, Christoph Dehner, M Schultheiss, Peter H RichterAbstract:: Hybrid-Operating Rooms enable the surgeon to acquire intraoperative high-resolution 2- and 3D images and use them for navigation. The radiation dose of the Operating personal and the patient remains the major concern. In 9 months, 109 pelvic and spine cases were performed using a Hybrid Operating Room. Radiation dose of the surgeon and the assisting nurse was recorded using real-time dosimeters. Lower radiation doses for the main surgeon in navigated dorsal instrumentations of the thoracic spine were recorded. Standing between the C-arm during screw placement increased the radiation dose sixfold. Lumbar dorsal instrumentation showed a similar radiation dose compared to the previous studies in traditional Operating Room settings. The use of a Hybrid-Operating Room for dorsal spine instrumentation showed no increase in radiation dose compared to traditional settings. Intraoperative navigation can help to reduce the radiation dosage for the Operating personnel.
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radiation exposure for intraoperative 3d scans in a Hybrid Operating Room how to reduce radiation exposure for the surgical team
International Journal of Computer Assisted Radiology and Surgery, 2018Co-Authors: Konard Schuetze, Florian Gebhard, M Kraus, Alexander Eickhoff, Peter H RichterAbstract:Background Hybrid Operating Rooms are used in different fields of surgery. In orthopedic surgery, the possibility of a 3D scan of difficult anatomical regions (spine, pelvis) showed promising results not only in navigated screw placement. The associated exposure to radiation raises questions regarding potential risks for the Operating Room personal and the patient. The present study focuses on scatter radiation during 3D scans in a Hybrid Operating Room, the adjacent Rooms, and methods to reduce radiation exposure.
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accuracy of computer assisted iliosacral screw placement using a Hybrid Operating Room
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Peter H Richter, Florian Gebhard, Christoph Dehner, Alexander ScolaAbstract:Abstract Introduction In recent years Hybrid Operating Rooms were established all over the world. In our setting we combined a 3D flat-panel c-arm (Artis zeego, Siemens) with a navigation system (BrainLab curve, BrainLab). This worldwide unique combination enables the surgeon to visualise an entire pelvis in CT-like image quality with a single 3D-scan. The aim of our study was to investigate, if utilisation of a Hybrid Operating Room increases the accuracy of SI-screws in comparison to standard 3D-navigation. Material and methods Retrospective, not randomised single centre case series at a level I trauma centre. Inclusion criterion was insertion of a percutaneous iliosacral screw using image-guidance in the Hybrid Operating Room. 61 patients (35 female, 26 male) were included from June 2012 till October 2014. 65 iliosacral screws were inserted. Intraoperative 3D-scans and postoperative scans were examined to investigate screw placement. The results were compared to a preceding study performed in 2012 using conventional 3D-navigation. Statistical calculations were performed with Microsoft Excel 2011 and SPSS. Results 65 iliosacral screws were implanted. Two different types of screws were implanted: 1. “Standard” iliosacral screws stabilizing one joint/a unilateral fracture. 2. Single SI-screws stabilizing both SI-joints and if present a bilateral fracture. Forty one patients were included in group 1 (screws n = 45). There was no perforation in 43 screws, grade 1 perforation in 2 screws. There was no grade 2 or 3 perforation in this group. Compared to the conventional 3D-navigated screws there was a highly significant difference ( p Conclusion Improvements in image quality and enlargement of the display window lead to better intraoperative visualisation of the entire dorsal pelvis. Thereby the accuracy of computer-assisted iliosacral screws could be increased using a Hybrid Operating Room. Furthermore difficult tasks like a single screw for both joints can be accomplished.
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one year orthopaedic trauma experience using an advanced interdisciplinary Hybrid Operating Room
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Peter H Richter, Seth R Yarboro, M Kraus, Florian GebhardAbstract:Abstract Hybrid Operating Rooms have been used successfully in several surgical specialties, but no data have been published for orthopaedic trauma. We present our one-year orthopaedic trauma experience using a Hybrid Operating Room, which incorporates 3D fluoroscopic imaging as well as navigation capabilities. Data were compiled for a series of 92 cases performed in an advanced Hybrid Operating Room at the level one trauma center in Ulm, Germany. All patients who had surgery performed using this Operating Room during the first year were included. Setup time and surgical complications using Hybrid Operating Room were recorded and analysed. The Hybrid Operating Room resulted in no higher rate of complication than expected from the same cases in a conventional Operating Room. The Hybrid Room did however allow the surgeon to confidently place implants for orthopaedic trauma cases, and was most advantageous for spine and pelvis cases, both minimally invasive and conventional. Further, appropriate reduction and implant position was confirmed with 3D imaging prior to leaving the Operating Room and obviated the need for postoperative CT scan. Based on our one-year experience, the Hybrid Operating Room is a useful and safe tool for orthopaedic trauma surgery.
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the Hybrid Operating Room home of high end intraoperative imaging
Unfallchirurg, 2012Co-Authors: Florian Gebhard, Peter H Richter, C Riepl, A Liebold, H Gorki, R Wirtz, Ralph Konig, F Wilde, A Schramm, M KrausAbstract:: A Hybrid Operating Room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.
Florian Gebhard - One of the best experts on this subject based on the ideXlab platform.
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radiation exposure for the surgical team in a Hybrid Operating Room
Journal of Robotic Surgery, 2019Co-Authors: Konard Schuetze, Florian Gebhard, Alexander Eickhoff, Christoph Dehner, M Schultheiss, Peter H RichterAbstract:: Hybrid-Operating Rooms enable the surgeon to acquire intraoperative high-resolution 2- and 3D images and use them for navigation. The radiation dose of the Operating personal and the patient remains the major concern. In 9 months, 109 pelvic and spine cases were performed using a Hybrid Operating Room. Radiation dose of the surgeon and the assisting nurse was recorded using real-time dosimeters. Lower radiation doses for the main surgeon in navigated dorsal instrumentations of the thoracic spine were recorded. Standing between the C-arm during screw placement increased the radiation dose sixfold. Lumbar dorsal instrumentation showed a similar radiation dose compared to the previous studies in traditional Operating Room settings. The use of a Hybrid-Operating Room for dorsal spine instrumentation showed no increase in radiation dose compared to traditional settings. Intraoperative navigation can help to reduce the radiation dosage for the Operating personnel.
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radiation exposure for intraoperative 3d scans in a Hybrid Operating Room how to reduce radiation exposure for the surgical team
International Journal of Computer Assisted Radiology and Surgery, 2018Co-Authors: Konard Schuetze, Florian Gebhard, M Kraus, Alexander Eickhoff, Peter H RichterAbstract:Background Hybrid Operating Rooms are used in different fields of surgery. In orthopedic surgery, the possibility of a 3D scan of difficult anatomical regions (spine, pelvis) showed promising results not only in navigated screw placement. The associated exposure to radiation raises questions regarding potential risks for the Operating Room personal and the patient. The present study focuses on scatter radiation during 3D scans in a Hybrid Operating Room, the adjacent Rooms, and methods to reduce radiation exposure.
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accuracy of computer assisted iliosacral screw placement using a Hybrid Operating Room
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Peter H Richter, Florian Gebhard, Christoph Dehner, Alexander ScolaAbstract:Abstract Introduction In recent years Hybrid Operating Rooms were established all over the world. In our setting we combined a 3D flat-panel c-arm (Artis zeego, Siemens) with a navigation system (BrainLab curve, BrainLab). This worldwide unique combination enables the surgeon to visualise an entire pelvis in CT-like image quality with a single 3D-scan. The aim of our study was to investigate, if utilisation of a Hybrid Operating Room increases the accuracy of SI-screws in comparison to standard 3D-navigation. Material and methods Retrospective, not randomised single centre case series at a level I trauma centre. Inclusion criterion was insertion of a percutaneous iliosacral screw using image-guidance in the Hybrid Operating Room. 61 patients (35 female, 26 male) were included from June 2012 till October 2014. 65 iliosacral screws were inserted. Intraoperative 3D-scans and postoperative scans were examined to investigate screw placement. The results were compared to a preceding study performed in 2012 using conventional 3D-navigation. Statistical calculations were performed with Microsoft Excel 2011 and SPSS. Results 65 iliosacral screws were implanted. Two different types of screws were implanted: 1. “Standard” iliosacral screws stabilizing one joint/a unilateral fracture. 2. Single SI-screws stabilizing both SI-joints and if present a bilateral fracture. Forty one patients were included in group 1 (screws n = 45). There was no perforation in 43 screws, grade 1 perforation in 2 screws. There was no grade 2 or 3 perforation in this group. Compared to the conventional 3D-navigated screws there was a highly significant difference ( p Conclusion Improvements in image quality and enlargement of the display window lead to better intraoperative visualisation of the entire dorsal pelvis. Thereby the accuracy of computer-assisted iliosacral screws could be increased using a Hybrid Operating Room. Furthermore difficult tasks like a single screw for both joints can be accomplished.
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one year orthopaedic trauma experience using an advanced interdisciplinary Hybrid Operating Room
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Peter H Richter, Seth R Yarboro, M Kraus, Florian GebhardAbstract:Abstract Hybrid Operating Rooms have been used successfully in several surgical specialties, but no data have been published for orthopaedic trauma. We present our one-year orthopaedic trauma experience using a Hybrid Operating Room, which incorporates 3D fluoroscopic imaging as well as navigation capabilities. Data were compiled for a series of 92 cases performed in an advanced Hybrid Operating Room at the level one trauma center in Ulm, Germany. All patients who had surgery performed using this Operating Room during the first year were included. Setup time and surgical complications using Hybrid Operating Room were recorded and analysed. The Hybrid Operating Room resulted in no higher rate of complication than expected from the same cases in a conventional Operating Room. The Hybrid Room did however allow the surgeon to confidently place implants for orthopaedic trauma cases, and was most advantageous for spine and pelvis cases, both minimally invasive and conventional. Further, appropriate reduction and implant position was confirmed with 3D imaging prior to leaving the Operating Room and obviated the need for postoperative CT scan. Based on our one-year experience, the Hybrid Operating Room is a useful and safe tool for orthopaedic trauma surgery.
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the Hybrid Operating Room home of high end intraoperative imaging
Unfallchirurg, 2012Co-Authors: Florian Gebhard, Peter H Richter, C Riepl, A Liebold, H Gorki, R Wirtz, Ralph Konig, F Wilde, A Schramm, M KrausAbstract:: A Hybrid Operating Room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.
