By Sybilann Williams, Janet S. Rader (auth.), Janet S. Rader M.D., Neil B. Rosenshein M.D. (eds.)
Ultrasonic surgical suggestions have been first utilized by Dr. Kelman within the Sixties to fragment cataracts via a 2-mm incision taking into account minimally invasive surgical procedure. the consequences from this approach encouraged the improvement of a bigger, flow robust ultrasonic unit that was once utilized in neurosurgery. This device allowed the neurosurgeon to selectively get rid of tumor tissue with lowered blood loss and tissue trauma. the facility now of ultrasonic gear to selectively fragment, irrigate, and aspirate tissue with minimum coagulation impression spurred its swift use in surgical procedure at the liver, spleen, kidney, and different intra-abdominal organs. This software has been valuable in ovarian melanoma cytoreduction and complex segmental organ resection. the most recent technical advancements contain electro cautery strength equipped into the hand piece and prolonged hand items for laparoscopic surgical procedure. The impetus for assembling this quantity has been to supply an intensive overview of the sphere of ultrasonic surgical procedure because it has at the moment constructed together with rules, gear good points, and surgical tech niques. it truly is was hoping that the data should be of use to physicians in education and surgeons in perform. The publication takes a multidisciplinary procedure with chapters authored through a variety of subspecialists in gen eral surgical procedure, urology, surgical oncology, and gynecologic oncology. each one bankruptcy comprises simple details on surgical thoughts. jointly, those chapters disguise surgical procedure of the GI tract, kidney, liver, and decrease genital tract, and current a couple of own approaches.
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The submucosal layer is resistant to destruction. Persistent exposure to ultrasonic fragmentation will gradually remove the submucosal layer, exposing the underlying circular muscle fibers. The muscular layer is soft and easily perforated by the ultrasonic probe. Therefore, great care is reguired to preserve the muscular fibers when Figure 4-3. Gross appearance of rectum following ultrasonic mucosal proctecromy. The mucosal layer and most of the submucosa has been removed. 41 4. Use of Ultrasonic Fragmentation in Colorectal Surgery Figure 4-4.
13 - 15 Unfortunately, problems with nipple valve continence have often required surgical revisions in patients undergoing this procedure. 16-18 The increased emphasis on the preservation of sphincter function with the simultaneous eradication of the disease has produced various operations in which the diseased rectal mucosa is removed while preserving the sphincter mechanism. Total abdominal colectomy with mucosal proctectomy and ileoanal anastomosis offers several advantages over proctocolectomy and ileostomy.