Microsurgical skills training скачать в хорошем качестве

Microsurgical skills training

. Although extensive theoretical teaching program is made for a neurosurgeon, there should be more emphasis for practical skill training. • Precision or pen grip should be preferred for better precision, and to avoid fatigue. • If power grip is needed, pen type of grip should be added to improve precision • Quiet hand technique using intrinsic muscles of thumb and index finger should be practiced with hand well supported • Body parts should be in comfortable position • Long length instruments also should be supported by other hand or on operative corridor • Instrument should be as short length as possible, angled tip, bayonet shape, round shaft, single limb and two functions can be added in one • Surgical trajectory should be in long axis of tumor and 90 degree to floor • If capsule is not separating from surrounding tissue, most of the time it is due to thick capsule. Decompress further, remove more tissue , it will be easy to find cleavage between tumor capsule and surrounding tissue. • Movement by rotation rather than linear movement is helpful in narrow corridor. • Gentle traction and counter traction in opposite direction is needed for dissection • Bimanual dissection is needed for control of bleeding, cutting and tissue dissection • Retractor arms and blades are curved in such as way that it is lying in close contact with operative field,(should be resting on surface) • Retracting blade should be at highest level, and tightening knob should be at lower height. • Hole on the suction should be large enough to make suction pressure zero when hole is open. • Suction pressure should be mild, just capable to suck blood or fluid only and not brain tissue especially near brain stem, thalamus, hypothalamus, nerve • Hand should be stabilized and hold drill like a pen, use small to and fro motion in light painting brush action • Entry of bone dust in subarachnoid space and injury to adjoining structures should be prevented by use of rubber gloves, Wet Abgel, Flat bone wax to protect surrounding structure. • Separate dura from bone, take bite, release and partially withdraw, genteelly, catch proximal bone, and remove nibbled bone after displacing it by Kerrisons punch foot • Observing live surgery, watching operative workshops, and videos, visiting other departments and observing skillful neurosurgeon and practice in Lab using cadaver, animal Model and artificial models help in improving surgical skills