Positioning Techniques in Surgical Applications - part 10 pps

Chapter 21 · Paediatric surgery284 21 21.1.3 Lateral position . Figs. 21.11–21.16. Indications Congenital deformities to the oesophagus (e.g. oesophagus atresia, oesopha- gus duplications), open and minimally invasive procedures to the lungs (e.g. sequestra, bronchiectasis, tumours). Lateral position on the healthy side, position on the left-hand side for oesophagus atresia Preparations 4 Gel cushions/sandbags, possibly wedge cushion 4 Gel cushions for the legs 4 Leg holders (only for larger children) 4 Padding for the legs and feet 4 Warming mat, warming lamp Positioning 4 Children’s operating table in the neutral position 4 Connect the warming mat and lamp, affix the temperature sensor 4 Prepare and induce the anaesthetic in the supine position 4 Transfer to the lateral position in the operating theatre 4 The upper arm is positioned in the cranial direction, padded and fixed in a cloth sling to the anaesthetic screen, for infants the arm is fixed in a lying position at the head with plaster strips 4 In larger children, pull the lower arm so that the body weight does not lie directly on the shoulder and extend in this position 4 Stabilise the body with sandbags or gel cushions, possibly wedge cushions 4 Fix the lower leg with body belts for older children and plaster strips for younger children 4 Pad the parts of the body at risk from pressure 4 Apply the neutral electrode, connect to the HF surgery device 4 Use compresses to protect the electrode during disinfection 4 Position the operating lamps Risks 4 Positioning injuries from lacking or inadequate padding (particularly for the face and genitals) 4 Burns from lacking moisture protection for the neutral electrode 21.1 · Various positions 21 285 . Fig. 21.16. Lateral position for lower lobe resection . Fig. 21.15. Arm positioning . Fig. 21.14. Padding under the legs. Fig. 21.13. Padding under the back . Fig. 21.11. Modified lateral position for thoracoscopy . Fig. 21.12. Arm spread out, fixed to the anaesthesia screen Chapter 21 · Paediatric surgery286 21 21.1.4 Lithotomy position . Figs. 21.17–21.21. Indications Rectoscopy, cystoscopy and procedures to the anus and rectum (e.g. abscesses, perianal vein thrombosis). Preparations 4 Two leg holders, pads for the legs 4 Warming mat, warming lamp 4 Arm position device only for older children Positioning 4 Children’s operating table in the neutral position 4 Connect the warming mat and lamp, affix the temperature sensor 4 Prepare and induce the anaesthetic in the supine position 4 Spread out and pad the arms of older children 4 Fit the leg holders to the corresponding clamps 4 Position the legs and remove the leg plates 4 For infants, the legs can be hung in slings or from the anaesthesia screen 4 Position the pelvic just above the edge of the buttocks plate 4 Lower the still raised legs until the thighs are almost horizontal 4 Pad the parts of the body at risk from pressure 4 Position the operating lamps Risks 4 Positioning injuries from lacking or inadequate padding (particularly for the face and genitals) 4 Burns from lacking moisture protection for the neutral electrode 21.1 · Various positions 21 287 . Fig. 21.17. Cystoscopy, padded leg holders . Fig. 21.21. Padding of the legs . Fig. 21.20. Lateral view of the positioning. Fig. 21.19. Lateral view of the positioning . Fig. 21.18. Spreading the legs out at right angles 22 22 Special aspects of Iso-C3D and navigation applications 22.1 Iso-C3D applications with and without navigation – 290 22.1.1 Vertebral column – 290 22.1.2 Pelvis/acetabulum – 294 22.1.3 Elbow/wrist – 296 22.1.4 Hips/DHS/neck of the femur: screwed solutions – 298 22.1.5 Head of the tibia and lower leg – 300 22.1.6 Ankle/pilon/talus – 302 22.1.7 Calcaneus fractures – 304 Chapter 22 · Special aspects of Iso-C3D and navigation applications290 22 22.1 Iso-C3D applications with and without navigation Basic ISC-C3D applications. During operations to the extremities, the extremity not being operated does not disturb much in the ray path, only the cube in the Iso centre (12×12×12 cm) is calculated and displayed. A carbon operating table should always be used whenever possible. If an operating table contains metal bracing, the region being scanned must be positioned centrally on the table, or in the case of the hand or feet, the ex- tremity can be allowed to hang over the edge of the table. The Iso C-arm is covered with special sterile foil. In addition, the operation site should also be covered with sterile sheets. One useful method consists of wrapping the extremity in a stockinette. It is also advisable to wrap the table in a sterile sheet so that the device can rotate around the table. In the case of the VIWAS table (single-section carbon operating table top), care must be taken to ensure that the duplex columns are as far as possible from the position of the C-arm. Losses in quality can be caused above all when the region being examined is not positioned exactly in the central ray path. Such a central position should be correctly adjusted and verified in both levels before starting the scan. Bumping into the C-arm during the automatic orbital movement always means that the scan has to be aborted. Navigation. The specific set-up must be known already before beginning the operation, and started before the operation or parallel to positioning the patient. Particular attention should be given to the position of the camera. The units/camera positions described here are rated specifically for systems with autonomous camera as autonomous unit (e.g. Optotrack/Medi- vision). 22.1.1 Vertebral column . Figs. 22.1–22.6. Iso-C3D imaging Prone position 4 Position the patient in the middle of the table, pay attention to table top height and patient height, because the C-arm gap is limited. 4 Choose a flat carbon table top (e.g. 1150.16) for obese patients. 4 Do not use metallic bolsters (MHH), cushions should be the preferred positioning aids. 4 In the single-section carbon VIWAS table, the gap in the C-arm is too small in some cases. 4 When scanning the thoracic vertebral column, as far as possible use the respiratory standstill in expiration to avoid movement artefacts. 4 In the case of dorsal instrumentation, proceed with the scan before app- lying the longitudinal and transfer connectors to reduce the artefacts. 22.1 · Iso-C3D applications with and without navigation 22 291 . Fig. 22.1. CRP operating table 1150.16, prone position and use of the image inten- sifier . Fig. 22.3. Maximum longitudinal displace- ment of the CRP operating table 1150.16 towards the head . Fig. 22.2. CRP operating table 1150.16, prone position on padding cushions Chapter 22 · Special aspects of Iso-C3D and navigation applications292 22 Positioning The side positioning is not really relevant, but coordination and exact posi- tioning is better from the side opposite the surgeon. Iso-C3D navigation 4 The Iso C assisted spinal operation is only possible on a carbon tabletop. 4 The Iso C-arm comes from the side opposite the surgeon, just like the navigation device. 4 Cover the operating site with sterile sheets, and also the Iso C. 4 The reference base (RB) must protrude out of the sterile covering. 4 In addition, a covering of sheets can be placed under the table as complete protection. 4 The Iso C can be used as a normal image converter in the lateral position. 4 The camera is placed at the end of the table or foot end. 4 The reference base (RB) points to the foot end or to the camera. 4 The monitor, C-arm and navigation device are positioned next to each other opposite the surgeon. Fluoroscopic navigation Prone position 4 Use a carbon table top. 4 Fluoroscopy scans at the start of the operation. To do so, cover the C-arm with sterile foil. 4 Positioning cushions should be given preference over bolsters. 4 The C-arm comes from the side opposite the surgeon. 4 During the operation, the C-arm remains in the lateral position and is covered with sterile sheets. 4 The camera is placed at the end of the table or foot end. 4 The reference base (RM) points to the foot end or to the camera. 4 The monitor, C-arm and navigation device are preferably positioned next to each other opposite the surgeon. 22.1 · Iso-C3D applications with and without navigation 22 293 . Fig. 22.4. Universal operating table 1150.30, CRP back plate 1150.45, prone position . Fig. 22.6. Maximum longitudinal displace- ment of the universal operating table 1150.30 towards the feet . Fig. 22.5. Universal operating table 1150.30, prone position on padding cushions [...]... position/spine holding device/skull holding device 194–196 – – Supine position/CRP horseshoe headrest 186–187 – – Supine position/skull clamp 188–189 – – Supine position/spine holding device MAQUET T554.0000 190–191 Spine holding unit/ head extension 89 Spray coagulation 43, 45, 49 – Definition 53 Staff sluice 8 Standard positioning (see also Positioning) 92 105 – Beach-chair position/sitting, half-sitting... (see there) 21, 29–30 – Indication, justifying 21, 23, 28 – Instructions, X-ray machine 24 – Leakage radiation 33, 36–37 – Mandatory information 29 – Monitoring area 24 – Obligations when operating an X-ray machine 24 – Postoperative X-rays 110 – Quality assurance as per X-ray Ordinance 29–30 – Scanning times 35 – Used machines 30 X-ray radiation in the operating suite 20–41 X-ray tube 31 ... – Supine position 174–176 – – Modified 180–181 Used equipment, X-ray 30 W Warming system for patients 90, 109 Wedge cushion 80 Whole-body scan 60 Wound cleaning 112 Wound infection 8, 10 – Measures 8 – Shaving 10, 111 Wrist, navigation (Iso-C3D general and with navigation) 196–197 X X-ray card 29 X-ray Ordinance 21, 29 – Principles of application of § 25 X-ray Ordinance 23 X-ray pictures/machine (see... Subject Index Image receiving system of surgical image intensifiers 31–33 – Correct positioning 34 Image saving and processing, digital 20 Image-assisted surgery (see also AWIGS/VIWAS) 60–67 Implementation responsibility 15 Indication, justifying 21, 23, 28 Infection 8 – Nosocomial 8 – Prevention 9 – Wound infection (see there) 8, 10, 111 Information 108 , 116 – for parents and children 5 Infusion arm 17 Instruction,... rolls for positioning 80 Röntgen, W.C 20, 30, 35 S Scanning times 35 Screw tension device 87 Scrub room 10 Shaving 10, 111 Shoulder luxation 120 Shoulder operations – Arthroscopic procedures 268–271 – Back plate for 84 – Positioning 218 Shunt arms, position-related 119 Skin and soft tissue injuries, positioning 117 Skin disinfection 113 Skull clamp 123 Sliding gantry (see also VIWAS) 66–67 Sliding rail... Lateral position 103 105 – Head 103 – Legs 104 105 – Paediatric surgery 284–285 – Positioning injuries 122 – Shoulder and arms 103 104 – Thoracic/lumbar spine 198–199 – Thorax and pelvis 104 – With vacuum mat 103 – Without vacuum mat 103 Law of the distance square 26, 31 Lead equivalent value 29 Leakage current 50 Leaking radiation 33, 36–37 Leg holder – Goepel leg holder 85 – with one-hand control 85... Arms 101 102 – Cervical spine (see there) 192–194 – Elbows 230–231 – Head 100 101 – Legs 102 103 – Paediatric surgery 282–283 – Positioning injuries 120–121 – Thoracic/lumbar spine 196–197 – Thorax and pelvis 102 – Upper arm 226–227 – Urology 182 Psychological management of children 4–6 Pure cut (smooth cut) 43, 45 Q Quality assurance according to the X-ray Ordinance 29–30 R Radial adjusting clamp... 43–44 – Blend cut 44 – Definition 53 – Smooth cut (»pure cut«) 43, 45 D Depilation 111 Desiccation 43–45 – Definition 51 DGHM list 10 DHS, navigation (Iso-C3D general and with navigation) 298–299 Diagnostic reference values (DRW) 21 Digital image saving and processing 20 Disinfectant 11 309 Subject Index Disinfection 10 – Cleaning hands and disinfection (see there) 9 10 – Procedure 10 Distribution of tasks... 9 10 – Hygienic 9 10 – Procedure 10 – Surgical 10 Hand operating table 84 Hand, supine position 232 Head cushions 80–82 – For supine position 82 Head extension, spine holding unit 89 Head plate adjustment, motordriven 89 Head ring 80–81 Heart massage 124 Heidelberg position (position for Kraske access) 168–169 Height adjustment operating table 68 Helpers/helping persons, radiation protection 23 High-frequency... for obese patients 4 In the VIWAS table with single-section carbon tabletop, the gap in the C-arm is too small, therefore always use another carbon tabletop 4 The body supports must be moved in the thoracic direction, side stability must be guaranteed without metal braces in the ray path Positioning The side positioning is not really relevant, but coordination and exact positioning is better from the . of the table. Positioning The side positioning is not really relevant, but coordination and exact posi- tioning is better from the extremity being operated. Iso-C3D navigation Supine position 4. almost horizontal 4 Pad the parts of the body at risk from pressure 4 Position the operating lamps Risks 4 Positioning injuries from lacking or inadequate padding (particularly for the face and. the positioning. Fig. 21.19. Lateral view of the positioning . Fig. 21.18. Spreading the legs out at right angles 22 22 Special aspects of Iso-C3D and navigation applications 22.1 Iso-C3D applications