Fess смотреть последние обновления за сегодня на .

Functional endoscopic sinus surgery (FESS) - 3D animation


This medical animation describes the functional endoscopic sinus surgery (FESS), or commonly known as sinus surgery, is minimally invasive surgical procedure for serious sinus conditions. Medical professional use the term “functional” because the surgery is done to restore how your sinuses work, or function. Healthcare providers use nasal endoscopes — thin tubes with lights and lens — to ease your sinus symptoms without making incisions in or around your nose. Studies show between 80 % and 90% of people who’ve had this surgery feel it solved their sinus issues. How is functional endoscopic surgery performed? A decongestant medication is inserted in your nose, followed by a nasal endoscopy. An injection of a numbing solution is inserted into your nose, and the endoscope is inserted gently. Surgical tools are used alongside the endoscope to remove bone, diseased tissue or polyps that may be blocking your sinuses. Most functional endoscopic surgeries last about two hours. This 3d animation is licensable for healthcare providers to assist with their patient education. For more information about licensed or custom 3D animations, visit 🤍 Watch additional medical animations: Craniectomy brain surgery - 3D animation: 🤍 Accessing an implantable port training - 3D animation: 🤍 Open Suctioning with a Tracheostomy Tube - 3D animation: 🤍 Ventriculostomy Brain Surgery - 3d animation: 🤍 Suctioning the endotracheal tube - medical animation: 🤍 How to insert a nasogastric tube for NG intubation - 3d animation: 🤍 Oral airway insertion - oropharyngeal airway technique - 3D animation: 🤍 Nasotracheal suctioning (NTS) - 3D animation: 🤍 Learn about hemorrhoids with #3d #animation: 🤍 LASIK eye surgery - 3D animation: 🤍 CPR cardiopulmonary resuscitation - 3D animation: 🤍 What are warts (HPV)? - 3D animation: 🤍 How Macular Degeneration Affects Your Vision - 3D animation: 🤍 NeoGraft hair transplant procedure – animation: 🤍

Functional Endoscopic Sinus Surgery (FESS) with Microdebrider


Please be advised that this video contains graphic footage of surgery. This video demonstrates the microdebrider technique for functional endoscopic sinus surgery performed by Dr. Erin K. O'Brien. Series Editors: Andrew J. Goates, M.D.; Matthew L. Carlson, M.D. To learn more about the Department of Otorhinolaryngology at Mayo Clinic, visit 🤍

Full Functional Endoscopic Sinus Surgery (FESS) for sinusitis


Mount Sinai sinus surgeons (Govindaraj, Alicea, Del Signore, Iloreta, Schaberg, Shah, Wei, Mra, Sands, Shin, Tweel, and Zeiger) specialize in minimally invasive, functional endoscopic sinus surgery (FESS) for patients with chronic rhinosinusitis and sinusitis with or without nasal polyps. Sinus surgery for inflammatory disease allows medications such as nasal steroids, saline irrigations, and antihistamines to better reach their target areas. Polyp removal may also improve nasal congestion and nasal obstruction. This procedure is commonly performed along with septoplasty and inferior turbinate reduction to further open the nasal airways to improve breathing through the nose. Not all sinuses must be opened in order for surgery to be effective; surgeons will open a combination of the following sinuses: maxillary, ethmoid, frontal, and sphenoid on one or both sides. The extent of surgery is dependent on symptoms, anatomy, and the results of a CT scan. Sinus surgery is very effective in well-selected patients. For more information, go to: 🤍 🤍 🤍 The Mount Sinai Otolaryngology Surgical Video Series was edited by Dr. Zachary Schwam.

Full House FESS: Step-by-Step Training Video by Prof. Georgalas


This is a full house FESS step-by-step training video showing the main steps of endoscopic sinus surgery, including middle meatal antrostomy, anterior and posterior ethmoidectomy and Draf 2 sinusotomy. Extensive use of animation, radiological images and navigation images are used to enhance understanding of anatomy, key landmarks and crucial surgical manoeuvres. In the video Prof. Georgalas is using the Olympus shaver system (Diego Elite) as well as the Olympus 4K video system, lens cleaner, hand instruments and video recorder. 00:00 Intro 00:56 Nasal Endoscopy 01:35 Uncinectomy and Middle Meatal Antrostomy 02:29 Anterior Ethmoidectomy 03:04 Transnasal Sphenoidectomy 03:54 Retrograde Posterior Ethmoidectomy 05:09 Frontal Sinusotomy / Draf 2a 06:34 Right Side 07:05 Uncinectomy Middle Meatal Antrostomy 07:49 Anterior Ethmoidectomy 08:08 Sphenoidotomy 08:37 Retrograde Posterior Ethmoidectomy 08:50 Frontal Sinusotomy / Draf 2a 09:22 Finalised Full House FESS

4K Full House FESS (Functional Endoscopic Sinus Surgery) - Prof. Richard Harvey


Professor Richard Harvey (Rhinologist & Skull Base Surgeon, Sydney, New South Wales), performs a Full House FESS procedure utilizing the Olympus 4K UHD imaging platform and Diego Elite Multidebrider. Learn more about the Olympus VISERA 4K UHD imaging system and the DIEGO ELITE Multidebrider: 🤍 🤍 The video has been provided by the Olympus Academy (Olympus Australia & New Zealand). S00066EN

FESS- Frequently Asked Questions


Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure to treat chronic sinusitis. Functional endoscopic sinus surgery (FESS) is an outpatient procedure that is performed under local anesthesia. The surgeon uses a fiberoptic endoscope to visualize nasal passage for the removal of the uncinate process of the ethmoid bone. An otolaryngologist who has expertise in the surgical treatment of the ear, nose, and throat is the right doctor for consulting for Functional endoscopic sinus surgery (FESS). The overall success rate of people who have had Functional endoscopic sinus surgery (FESS) is above 90% and also depends on how far the sinusitis has been treated. There are mandatory follow-up visits at one week, three weeks, and six weeks after Functional endoscopic sinus surgery (FESS). For treatment assistance in your country or abroad: Submit your inquiry online at 🤍 Email: hello🤍vaidam.com Phone/WhatsApp/Viber: +91-9650001746 Website: 🤍vaidam.com Vaidam is an ISO and NABH accredited medical assistance company. Patients from 100+ countries have used our services. Useful Links: India About: 🤍 Doctors: 🤍 Hospitals: 🤍 Cost: 🤍 Turkey About: 🤍 Doctors: 🤍 Hospitals: 🤍

Module 1: Functional Endoscopic Sinus Surgery (FESS)


Module 1: Functional Endoscopic Sinus Surgery (FESS) Video Details: Captured from the Advanced Skull Base (Rhinology) Dissection Workshop February 2018, University of Malaya Medical Centre, Kuala Lumpur, Malaysia Dissector and Narrator: Professor Dato' Dr. Prepageran Narayanan, Senior Consultant in Otorhinolaryngology and Head & Neck Surgery, University of Malaya. Video Editors: Dr. Liew Yew Toong & Dr. Eugene Wong

ENT FESS Functional Endoscopic Sinus Surgery Types Indications Uses


15:10 Revision Part 2 🤍

Functional endoscopic sinus surgery (FESS) - Online interview


Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure used to treat chronic sinus infections. In our latest online interview, we asked highly esteemed consultant ENT rhinoplasty surgeon, Mr Ali Qureishi, to explain what patients should expect before, during and after FESS. If you think that FESS could help you with sinus problems or would like more information about the procedure, you can go to Mr Qureishi's Top Doctors profile to book a consultation: 🤍 ✔  Follow us on Instagram: 🤍 ✔  Follow us on Facebook: 🤍 ✔  Follow us on Twitter: 🤍

Balloon Sinuplasty and FESS Animation


Balloon Sinuplasty by accalrent

Endoscopic Fess Sinus Surgery (ENT) Instruments Detailed Review | New Med Instruments


New-Med Instruments manufacturing Complete range of ENT Instruments, Here's a look of our Review on our Famous " Fess Endoscopic Sinus Surgery Instruments Set" Please visit this link to Purchase OR see more details on this set :- 🤍 Contact us by WhatsApp for Quick Communication at +923346502333 New-Med Instruments manufacturing Instruments for Surgeons around the world to enhance their surgery results, Our Instruments are perfect for Surgeons who value perfect & Precise results for their patients..

Complete endoscopic sinus surgery - Systematic front to back approach


SYSTEMATIC FRONT TO BACK APPROACH TO THE PARANASAL SINUSES - COMPLETE ENDOSCOPIC SINUS SURGERY. This is a demonstration of a complete endoscopic sinus surgery using the vertical lamellas concept, swing door technique and intact bulla technique to the frontal recess. Enjoy! More content on Instagram account 🤍doctorbartel #nasalpolyps #endoscopicsinussurgery #FESS #ESS #rhinosinusitis #sinusitis #otolaryngologist #entsurgery #otolaryngology #orl #meded #medicaleducation #rhinology #skullbasesurgery

FESS Unedited ( Case 1 ) - Dr. Satish Jain - www.skullbase360.in ...


I created this video with the YouTube Video Editor (🤍

FESS Unedited ( Case 2 ) - Dr.Satish Jain - www.skullbase360.in


Yet another mind blowing demonstration of FESS by Dr. Satish Jain sir . Audio and Video unedited. Download whole video by software 🤍

SurgTech Full House FESS


See more at SurgTech.net Authors: Martyn Barnes Richard Douglas

Jak wygląda Funkcjonalna Endoskopowa Operacja Zatok - FESS


Przedstawiamy Państwu Funkcjonalną Endoskopową Operacja Zatok - FESS. Głównym celem tej metody jest precyzyjne usunięcie zmian w obrębie ujścia zatok przynosowych, powodujących zaburzenia wentylacji. Dzięki zastosowaniu endoskopów optycznych możliwe jest dokładne usunięcie wszelkich zmian blokujących ujścia zatok przynosowych (m.in. polipów nosa), wytworzenie szerokiego połączenia pomiędzy jamą nosa i zatokami przynosowymi. Więcej informacji: 🤍 #endoskopowanaoperacjazatok #fess #operacjazatok #olimedica #laryngologia * Odwiedź nas: Facebook- 🤍 Instagram- 🤍 Nasz strona- 🤍



Dr. Meenesh Juvekar (INDIA) M.S (ENT), D.N.B, D.O.R.L, M.N.A.M.S Functional endoscopic sinus surgery (FESS) is the mainstay in the surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure. Computed tomography is used to assess the anatomy and identify diseased areas. Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed. The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort. The complication rate for this procedure is lower than that for conventional sinus surgery. Indications for Endoscopic Sinus Surgery Endoscopic sinus surgery is most commonly performed for inflammatory and infectious sinus disease. The most common indications for endoscopic sinus surgery are as follows: • Chronic sinusitis refractory to medical treatment • Recurrent sinusitis • Nasal polyposis • Antrochoanal polyps • Sinus mucoceles • Excision of selected tumors • Cerebrospinal fluid (CSF) leak closure • Orbital decompression (eg, Graves ophthalmopathy) • Optic nerve decompression • Dacryocystorhinostomy (DCR) • Choanal atresia repair • Foreign body removal • Epistaxis control Typically, endoscopic sinus surgery is reserved for patients with documented rhinosinusitis, based on a thorough history and a complete physical examination, including CT scans if appropriate, and in whom appropriate medical treatment has failed. An ENT surgeon of international repute, Dr Meenesh Juvekar completed his MS (Master of Surgery) in ENT from the renowned LMT Medical College, Mumbai in January 1999. He has to his credit, numerous academic achievements some of which include the first place in DNB Examinations of National Board, New Delhi held in May 1999 – he was awarded the Kameshwaran Gold medal for standing first in India. He also secured the third place in MS (ENT) Examination of Bombay University in January 1999. Currently Dr Meenesh Juvekar is Consultant ENT Surgeon at Bombay Hospital, Mumbai and at Juvekar Nursing Home, Mumbai. He is also Consultant at Fortis Hospital, Mulund. Additionally, Dr Juvekar became the President – Association Of Otolaryngologists – Mumbai at a very young age. He also organised a conference in Hong Kong in the Golden Jubilee Year. He is ex-Associate Professor and Unit Head of Department of ENT at K.J. Somaiya Medical College & Hospital, Mumbai. Dr Juvekar did his fellowship with Prof. Hildmann, Elisabeth Hospital, Bochum, Germany in Middle Ear surgery, and with Prof. Gubish, Marine Hospital, Stuttgart, Germany, in Rhinoplasty in the year 2000. He attended and assisted various surgeries during that period and also performed cadaveric temporal bone dissection under the guidance of Prof Hildmann, Bochum. Dr Juvekar is especially popular amongst his students right from the days of his lectureship for his ability to make the subject so simple and easy-to-learn. Not to mention that all this expertise comes from his hard work and the experience that he has gained during his tenure as an ENT surgeon so far. He has conducted numerous teaching programs and clinical courses not only for undergraduate and postgraduate students but also for residents and nursing staff. He has been invited many times on All India Radio (AIR) to educate the society on noise pollution, deafness and common problems in ear-nose-throat (ENT). Dr Meenesh has even authored a book titled ‘Short Notes In ENT’ which was released by Padmabhushan Dr. L. H. Hiranandani in 2006. The book is useful for both undergraduate and postgraduates. It covers all the common conditions seen in ENT practice and is also up-to-date with common ENT procedures including the latest in ENT such as LASERS. In all, the book contains 104 topics spanning the entire subject.

How is Functional Endoscopic Sinus Surgery Performed?


🤍. Dr Kevin Soh explains endoscopic sinus surgery using an example from a real case. He is treating a case of sinusitis and nose polyps using microdebrider surgery. Understand the different stages of the sinusitis operation as seen during live sinus surgery. 3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510 🤍 If you have any comments, PLEASE do not be afraid to ask. Please SUBSCRIBE, SHARE, and COMMENT on this video. If you prefer to read, rather than watch the video, here’s the transcript. 0:15 - FESS is a minimally invasive surgery used to restore: Sinus Health, Ventilation, and Drainage. 0:30 - A 40 year old man complains of: Block nose, mouth breathing, throat soreness, headaches, poor sleep quality, and chronic fatigue. 0:44 - Examination showed: Nasal polyps, Ethmoid sinusitis, Maxillary sinusitis, and Frontal sinusitis. 0:47 - Before I begin my operation, I read a little plaque on my desk for inspiration. 0:51 - The Prayer of a Physician. Endow me with the strength of heart and mind so that both may be ready to serve the rich and poor, the good and wicked, friend and enemy, and may I never see in the patient anything else but a fellow creature in pain. 0:57 - Nasal polyps are translucent. They look like a bunch of grapes. Lignocaine and adrenaline is given to decongest and anesthetize the nose. Cocaine packs are used to further decongest the nose. 1:27 - A microdebrider is used to remove the polyps. It is set to oscillating mode at 3,000 Hz. 2:20 - The uncinate process is now visible. Upper part of middle turbinate is seen. The anterior ethmoid sinus (bulla ethmoidalis) is seen. The anterior ethmoid sinus is entered. The ethmoid bones are as thin as paper. 4:00 - A polyp in the posterior ethmoid sinus is seen. Blakesley Wells forceps are used to remove the tiny bone fragments. A giant polyp from the posterior ethmoid sinus is removed. More ethmoid tissue is removed. 4:45 - The maxillary sinus opening is identified. Up biting forceps is used to widen the maxillary sinus opening. Back biting forceps is used to widen the front edge of the maxillary sinus opening. 6:09 - With a 30o Hopkin’s telescope, I can see right into the maxillary sinus. A curved suction is used to suck out the contents in the maxillary sinus. 6:39 - A curette is used to clean up the roof of the ethmoid sinus. With the 70o Hopkin’s telescope, the frontal sinus is seen. The middle turbinate is trimmed. 7:42 - The ethmoid sinus cavity is packed with absorbable Gelfoam. The nasal cavity is packed with Merocel. The Merocel pack is pushed upwards to allow the patient to breathe through the bottom of the nose. I put in the final touches, and the job is completed.

CASE 1 : FESS-Functional Endoscopic Sinus Surgery made simple.full house FESS lt side


here i have shown how to open each and every sinus step wise to avoid complications and damage to important anatomical structures . this video is for those who are new to sinus surgery and want to learn basics in sinus anatomy

Prevent POLYP recurrence | Why Nasal washes are important after FESS Surgery!!!


Join this channel to get access to perks: 🤍



#AREA #AREACSGO #AREACS2 #JulienAreaDubois #АРЕАКСГО #АРЕАКС2 - AREA ВЕРНУЛСЯ В CS:GO на моем канале, в видео я говорю, что AREA уже играл в cs 2 - это новая демка, которую никто не видел! AREACSGO - аимер который получил VAC BAN! Полное его имя Julien "Area" Dubois Большинство людей считает, что АРЕА читер, но он вернулся в cs:go, т.к вышла кс2, то ждем его в новой игре AREACS2. AREA покажет в cs 2 как тренировать аим... Julien потерялся, о нем не было слышно много времен.Надеюсь, что Dubois будет проводить стримы на своем канале. И все это в новой контер-страйк 2 - обновление кс2! Counter Strike 2 наше будущее. HStory AREA - FRAGMOVIE CS:GO - его фраги! AREA в Counter-Strike 2 не получит патруль - будем надеяться на это! Новая демка с его игрой, он вернулся в CS:GO и CS 2! AREA playing de_zoo 51/15 - такая оьщая статистика АРЕАКСГО не подведи АРЕАнистов, удачи в новой игре! ПОСЛЕДНЯЯ ДЕМКА AREA, где он настрелял 51 фраг - просто НЕРЕАЛЬНАЯ СТРЕЛЬБА! AREA 51 ФРАГ

Module 2: Powered Functional Endoscopic Sinus Surgery (FESS)


Module 2: Powered Functional Endoscopic Sinus Surgery (FESS) Video Details: Captured from the Advanced Skull Base (Rhinology) Dissection Workshop February 2018, University of Malaya Medical Centre, Kuala Lumpur, Malaysia Dissector and Narrator: Professor Dato' Dr. Prepageran Narayanan, Senior Consultant in Otorhinolaryngology and Head & Neck Surgery, University of Malaya. Video Editors: Dr. Liew Yew Toong & Dr. Eugene Wong

Balloon Sinuplasty and FESS Animation with Voiceover


Learn more about the Balloon Sinuplasty instruments and how they are used to help doctors treat patients with chronic sinusitis. For more information visit 🤍 Balloon Sinuplasty System is intended for use by or under the direction of a physician that is treated in the use of Balloon Sinuplasty Technology. Prior to use, it is important to read the Instructions for Use and to understand the contraindications, warnings, and precautions associated with this device. 060742-160926

Rhinocon 2022: Basic FESS


Captured from the Advanced Endoscopic Skullbase Cadaveric Dissection Workshop at 5th Rhinocon 2022, Pakistan Institute of Medical Sciences, Pakistan. Dissector and Narrator: Professor Dato' Dr. Prepageran Narayanan, Senior Consultant in Otorhinolaryngology and Head & Neck Surgery, University of Malaya, Malaysia. Video Editors: Dr. Loong Siew Ping

Fess Ka Fe Bang - DJ Madness X Mob - Easy TikTok Dance Choreography - Baile - Coreo


►TikTok: 🤍 ►Facebook: 🤍 ►Instagram: 🤍 ►Instagram Pim: 🤍 ►Subscribe for more dance videos: 🤍 ►Our webshop: 🤍 ►Instagram dancers 🤍 🤍 🤍 ►Choreo by: Saskia van Dijk We love to bring you joy with easy fitness choreography's! Our dance school has 2 locations in The Netherlands (Woerden - Harmelen). We teach classes Zumba, XCO, Keepfit, Body&Balance, streetdance/hiphop. DANCE*JUMP*SWEAT*ENJOY 🤍thestarfactory.nl - 🤍saskiasdansschool.nl




FESS for sinusitis, Dr Nishit Shah


short video detailing surgical steps for endoscopic surgery for sinusitis - FESS. Dr Nishit Shah

FESS cadaver dissection ( Video 1 ) - Prof. Stammberger


I created this video with the YouTube Video Editor (🤍

What is FESS / Functional Endoscopic Sinus Surgery? +FESS, #Endoscopicsinussurgery, #sinusitis|Hindi


This Video and the accompanying information is not a substitute for a medical consultation. FESS – Functional Endoscopic Sinus Surgery is routinely performed to treat various types of disease of the sinuses. FESS versus ESS – What is the difference? FESS relates to improving Function of the sinuses. In earlier times radical sinus obliteration surgeries were performed to treat sinus disease. However, Professor Messerklinger demonstrated that chronic sinus disease arose out of poor drainage from the sinus cavity. He postulated and proved that the way to treat chronic sinus disease was by improving the FUNCTION of the sinus – this was done by opening up natural drainage passages. So the surgery came to be called Functional Endoscopic Sinus Surgery (FESS). ESS on the other hand is any endoscopic assisted surgery done on the sinus – this may be for polyps, tumours etc. INDICATIONS OF FESS/ESS 1. Chronic sinusitis not responding to routine medication 2. Nasal Polyposis 3. For repair of CSF Rhinorrhoea 4. For Orbital decompression 5. Biopsy of suspicious lesions/ Removal of Tumours from the nose and sinuses 6. As an approach to the skull base for tumour removal or decompression 7. Other nasal and sinus lesions amenable to endoscopic removal/ management ANAESTHESIA The surgery can be performed under the following Anaesthesia - 1. Local Anaesthesia – after discussing with the patient – only Local Anaesthetic is used along with some sedation. 2. MAC- Monitored Anaesthesia Care- the anaesthetist gives pain reliving drugs intravenously, along with sedation. 3. General Anaesthesia – Full General Anaesthesia where the patient is completely unconscious. An oral pack is also kept in the throat. The decision regarding the type of anaesthesia to be used is taken following a discussion between the ENT surgeon and the patient. SURGICAL PROCEDURE The patient lies supine on the OT table and part is prepared and draped with surgical drapes. Cotton patties or Merocel pledgets soaked in 4 % Xylocaine with adrenaline or Saline with adrenaline are placed for decongestion. Sometimes 2 % Xylocaine with adrenaline is infiltrated locally into the parts to be operated. The rest of the steps follow the nature of the disease for which the surgery is being performed. In a routine FESS for Chronic unresolving Sinusitis the following steps may be followed - The uncinate process is incised – this offers access to the Maxillary sinus – either a backbiting forceps or sometimes a Microdebrider blade is used - The Maxillary sinus opening is widened and disease cleared - The Ethmoid air cells including the Bulla Ethmoidalis are cleared - The Frontal sinus is opened using angled endoscopes and the recess is opened - The Sphenoid sinus is opened and cleared of disease and sinus opened up widely - A nasal pack is applied after disease removal The steps may not follow this routine sequence as there may be many variations and will depend on the specific case. POST OPERATIVE PERIOD There is usually a nasal pack which remains in the nose for 1-2 days After pack removal the patient is called for follow up visits in which nasal crusts, blood clots etc are removed and cleaned. Post op visits are very important and must be adhered to. Normal simple home food is to be eaten. You cannot blow your nose since delicate nasal tissues are healing inside. Saline irrigations/ nasal douching is started a few days after the surgery. You can work from home but travelling outside, specially into dusty or polluted places is to be avoided. Once the tissue report (Biopsy/ Histopathology) is available you must discuss that with your ENT Surgeon. The recovery period is usually for about a week. Depending upon the diagnosis you may be called for periodic post op routine visits specially in case of Nasal Polyposis or Allergic Fungal Sinusitis. COMPLICATIONS Though fairly safe in experienced hands there are complications related to the procedure. - Bleeding - Infection - Recurrence of disease/ Polyps - CSF Rhinorrhoea - Blindness - Synechaie formation - Nasal Crusting FESS is a commonly performed nasal surgery and offers long standing benefit in properly indicated cases. For your ENT queries kindly contact - MedFirst ENT Centre. D 3/14, Vasant Vihar, New Delhi -110057. Please call at 9871150032, 9205585295 for an appointment.

Что ищут прямо сейчас на
fess เกมดัง ล้านวิว Reno2 Z Данон Afriki Овервотч Shuraim Spurs JBL Flip 6 الشلهوب plexo dejong ork lore şarkı als v4 麻醉 기본 urður Ark Survival Evolved Modded