ebook img

Practical Handbook for Small-Gauge Vitrectomy: A Step-By-Step Introduction to Surgical Techniques PDF

198 Pages·2012·8.991 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Practical Handbook for Small-Gauge Vitrectomy: A Step-By-Step Introduction to Surgical Techniques

Practical Handbook for Small-Gauge Vitrectomy Ulrich Spandau (cid:129) Heinrich Heimann Practical Handbook for Small-Gauge Vitrectomy A Step-By-Step Introduction to Surgical Techniques Authors Ulrich Spandau, M.D., Ph.D. Prof. Dr. med. Heinrich Heimann, M.D. Department of Ophthalmology St. Paul's Eye Unit Uppsala University Hospital Royal Liverpool University Hospital Uppsala Liverpool, Merseyside Sweden UK [email protected] [email protected] ISBN 978-3-642-23293-0 e-ISBN 978-3-642-23294-7 DOI 10.1007/978-3-642-23294-7 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2011941508 © Springer-Verlag Berlin Heidelberg 2012 Authorized translation of the 1st German language edition Spandau HH, 23G-Vitrectomie © 2009 by Kaden-Verlag, Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protec- tive laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by con- sulting the relevant literature. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) This book is dedicated to my teacher Zoran Tomic, who inspired me for retinal surgery. He is a pioneer in the development of bimanual surgery and in particular the bimanual removal of membranes. It is he, who should have written this book. Ulrich Spandau Foreword 1 (German Edition) In 2002 when the team of Eugene de Juan, Los Angeles, published their fi rst experi- ence of the transconjunctival sutureless vitrectomy with 25-gauge instruments, it could not be foreseen that the “small gauge vitrectomy” would become the new standard procedure of vitrectomy within a few years. Most retinal surgeons had previously considered the conjunctiva and sclera in a 20-gauge vitrectomy as a more or less troublesome and time-consuming obstacle before and after their true passion, the vitreous cavity. The extensive opening of the conjunctiva in conventional 20-gauge vitrectomy, the suture material used for the closure of sclera and conjunctiva and the sometimes wide-scale application of dia- thermy resulted often in a pronounced trauma of the outer layers of the eye. Thus, any revisional surgery became increasingly diffi cult due to the increased scarring of conjunctiva and Tenon’s capsule and the atrophy of the sclera in the pars plana. Due to their fl exibility, the fi rst 25-gauge instruments were initially only used for relatively simple vitreoretinal surgery at the posterior pole. However, the minimally invasive approach by de Juan was from the beginning fascinating, because not only was the extraocular part of a vitrectomy signifi cantly shortened, but the trauma of conjunctiva and sclera were also signifi cantly reduced. In 2004, inspired by de Juan’s method, Claus Eckardt developed a trocar cannula system and instruments with a diameter of 23-gauge in Frankfurt-Höchst. This invention had on one side the advantage of the 25-gauge vitrectomy and on the other side the effi ciency of the 20-gauge instruments. The aim was to carry out all possi- ble vitreoretinal surgery with the same instrumentarium, and this has since then become reality in our department. A key to the success of the 23-gauge technology step has been Claus Eckardt’s concept of a tangential insertion of the trocars and the use of valves for the cannulas: Due to the tunnel-shaped incision technique within the sclera, an intraoperatively stable positioning of the cannulas and a sutureless closure of the sclerotomies after removal of the cannulas, postoperative hypotension or even endophthalmitis could be prevented. The valves allow a vitrectomy in a closed system and reduce the fl ow of infusion fl uid through the vitreous cavity. Ulrich Spandau presents in this very practical book on 23-gauge vitrectomy the latest equipment and instruments needed for a 23-gauge vitrectomy and he explains in detail the most important surgical techniques. vii vviiiiii Foreword 1 (German Edition) A lot of useful tips, and last but not least the included DVD with a variety of surgical videos, make this book a very useful surgical compendium. This practical book will be a great guide for young ophthalmic surgeons who want to familiarize themselves with modern vitrectomy. Even experienced vitreoretinal surgeons, who wish to switch from 20-gauge to 23-gauge vitrectomy, will benefi t from this compendium. Frankfurt-Höchst, Germany Tillmann Eckert Foreword 2 Dr. Ulrich Spandau confi rms with this compendium to be the most dedicated of my so far eight fellows in vitreoretinal surgery. He presents here our current surgical concept, instrumentation and operative techniques that have been developed in Uppsala in the last 17 years. It is a transconjunctival, 23-gauge Microincision Vitrectomy Surgery (MIVS), combined with phaco-emulsifi cation in elderly patients, performed bimanually for the most of complex indications. To the best of my knowledge no comparable practical guide for current vitreoretinal surgery has been published since Zivojnovic’s S ilicone Oil in Vitreoretinal Surgery , in 1987. Since then vitreoretinal surgery has changed very much, from 20-gauge macroinci- sional vitrectomy with silicone oil tamponade in most of the cases, to 23-gauge microincisional, bimanual vitrectomy with gas tamponade that we use today. Dr. Spandau has opened a treasure box that he has fi lled patiently for several years and presents here some genuine surgical pearls, both those that he has discov- ered for himself, those that we have discussed together, those that I have shown him and furthermore those that were known since before. That gives an opportunity to both beginners and more experienced vitreoretinal surgeons to improve their practi- cal knowledge and refi ne their procedures in this fi eld. It is our duty to share all the surgical skills and knowledge with each other in order to provide the best results for our patients. This book is a genuine account of our practical work dedicated to them, which Dr. Spandau has written in collaboration with Dr. Heinrich Heimann. Thank you Ulrich and Heinrich! Dr. Zoran Tomic Chief Vitreoretinal Surgeon Department of Ophthalmology University Hospital Uppsala, Sweden ix

See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.