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PubMed1983

[Experimental study of a new technic of sutureless tubal anastomosis in the rabbit].

The authors have tested an original method of tubal anastomosis in the rabbit, which does not require suture material. The principle of the operation is the intubation of the ovarian tube by a silicone elastomere tube which acts as a guide for healing. From the 11 rabbits operated, the authors obtained 7 pregnancies, i.e. 63,6%. The results of this series do not appear to be any different from the pregnancy rates obtained by other teams with microsurgical techniques in the rabbit. The authors conclude that their method is as reliable, but more simple.

Animals↗
PubMed1989

New intraoperative brachytherapy techniques for positive or close surgical margins.

Tumors attached or adjacent to critical structures can often not be completely resected or resected with adequate surgical margins. Sites involving major blood vessels, the paravertebral spaces, or critical abdominal structures often present technical difficulties for standard brachytherapy procedures using I-125 or Ir-192 implants. These techniques allow for a high-dose delivery to the tumor bed with minimal normal tissue toxicity. A relatively simple and accurate method is described using I-125 seeds in Vicryl suture threaded through Gelfoam. These permanent implant procedures with radioactive I-125 seeds effectively treat small residual tumors or suspicious margins where standard brachytherapy techniques may be unsatisfactory and technically difficult to perform.

Adult↗
PubMed2006

A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair.

BACKGROUND: The optimal method for arthroscopic rotator cuff repair is not yet known. The hypothesis of the present study was that a double-row repair would demonstrate superior static and cyclic mechanical behavior when compared with a single-row repair. The specific aims were to measure gap formation at the bone-tendon interface under static creep loading and the ultimate strength and mode of failure of both methods of repair under cyclic loading. METHODS: A standardized tear of the supraspinatus tendon was created in sixteen fresh cadaveric shoulders. Arthroscopic rotator cuff repairs were performed with use of either a double-row technique (eight specimens) or a single-row technique (eight specimens) with nonabsorbable sutures that were double-loaded on a titanium suture anchor. The repairs were loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed. RESULTS: Gap formation during static loading was significantly greater in the single-row group than in the double-row group (mean and standard deviation, 5.0 +/- 1.2 mm compared with 3.8 +/- 1.4 mm; p < 0.05). Under cyclic loading, the double-row repairs failed at a mean of 320 +/- 96.9 N whereas the single-row repairs failed at a mean of 224 +/- 147.9 N (p = 0.058). Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure. The remaining five repairs did not fail, and a midsubstance tear of the tendon occurred. CONCLUSIONS: Although more technically demanding, the double-row technique demonstrates superior resistance to gap formation under static loading as compared with the single-row technique. CLINICAL RELEVANCE: A double-row reconstruction of the supraspinatus tendon insertion may provide a more reliable construct than a single-row repair and could be used as an alternative to open reconstruction for the treatment of isolated tears.

Arthroscopy↗
PubMed2004

Excisional biopsy of skin tumors.

The most frequently encountered neoplasm in the US is skin cancer. More than 600,000 new cases of malignant skin tumors are diagnosed in the US each year. One standard method of treatment of skin tumors is excisional biopsy. There are seven technical considerations involved in the excisional biopsy of skin tumors: (1) aseptic technique, (2) examination and demarcation of skin lesion, (3) skin biomechanical properties, (4) anesthesia, (5) excisional biopsy, (6) wound closure, and (7) postoperative care. The physician must use aseptic techniques and wear a cap, mask, and powder-free gloves. Hair is a source of wound contamination, and removal of hair prevents it from becoming entangled in suture and the wound during closure. Because surgical electric clippers cut hair close to the skin surface without nicking the skin, we now use only electric clippers to remove hair. The physician's visualization of the wound can be enhanced by magnification (2.5x) loupes. The physician's plan for excisional biopsy is dictated by the suspected pathology of the skin lesion. The ultimate appearance and function of a scar after closure of excisional biopsy can be predicted by the static and dynamic skin tensions on the surrounding skin. Infiltration anesthesia is preferred over regional nerve block because it does not interfere with the muscle movement that causes dynamic tensions, which elongate the configuration of the defect. Most skin lesions are amenable to a circular excision. In these instances, it is worthwhile to use circular-shaped excisions. The reusable metal trephines have been replaced by disposable trephines that have ribbed plastic handles attached to 316 stainless steel circular cutting blades. Wound closure is accomplished in the same direction as the long axis of the elliptical defect by first approximating the midportion of the defect with a 4-0 synthetic CAPROSYN* monofila-ment absorbable suture attached to the swage of the laser-drilled, compound-curved reverse cutting edge needle. Additional interrupted dermal (subcuticular) sutures are placed in each wound quadrant to approximate further the divided edges of the dermis. Compound-curved reverse cutting edge needles have been specifically designed for dermal closure. Reinforced Steri-Strips are then applied transversly across the incision to facilitate further skin edge approximation. Rigorous follow-up examination is essential for any patient with a history of a skin cancer to detect recurrence and prevent further actinic damage. The use of wide diameter trephine biopsy instruments are still not widely used by physicians because most physicians do not have the technical skills to approximate the defect with dermal sutures. Consequently, this need for a rapid dermal skin closure technique that can be used by a primary care physician must be devised before the trephine excisional biopsy technique is widely used by the primary care physician. This goal can be achieved by developing a disposable stapler for subcuticular closure of the skin.

Anesthesia, Local↗
PubMedDate not supplied

[Value of automatic sutures in total gastrectomy for cancer: apropos of 81 patients].

We reviewed the results of stapled circular (EEA) and linear (TA 30 or 55) anastomoses in a prospective study of 40 total gastrectomies for cancer, using an interposed jejunal limb (Henley technique). There were 63 circular anastomoses: 40 esophago-jejunal, 20 jejuno-duodenal and 3 jejuno-jejunal anastomoses. Forty patients were submitted to 41 linear stapled closures of the jejunal stump. Technical failure rate with stapled anastomoses was 5% (3 out of 63). Incidence of anastomotic leak was 6.3% for all the circular stapled anastomoses tried and 5% if the 3 technical failures were excluded. Anastomotic leakage is more often associated to splenopancreatectomy. One patient (1% of all the anastomoses) presented gastro-intestinal bleeding, related to the suture line. A conservative treatment was carried out successfully. The mean follow-up time of the surviving patients was 27 +/- 20 months: there was a 5.5% rate of late anastomotic stenosis; all the patients were cured by esophageal dilations. Late anastomotic stenosis is directly related to associated cobalt therapy. Analysis of an older retrospective series of 41 hand-sutured total gastrectomies allowed a comparison to be made between stapled and sutured anastomoses in total gastrectomy for cancer.

Adult↗
PubMed1978

[The Custodis procedure--technic and results (author's transl)].

Within the post 11 years 2,722 retinal detachments needed surgery. The mostly used procedure of Custodis consists in an implant, which covering the area of the hole is impressed into the sclera by mattress sutures. In 70% of our cases--due to Custodis--we succeeded in avoiding drainage of the subretinal fluid. Since 1966 the additional diathermy and/or lightcoagulation was mostly replaced by cryopexy. Summarizing the number of retinal detachments operated in the University clinic of Münster during 1955--1957 (Pau), 1958--1961 (Böke) as well as ours (1966--1977), 4,030 retinal surgeries (minus 10% encircling procedures) underwent within 18 years a Custodis procedure. The success rate of 85% indicates that Custodis' technic enables to optimal results.

Cryosurgery↗
PubMed1991

In vivo comparison of THC:YAG laser welding to sutured closure of biliary tissue.

Percutaneous endoscopic approaches to cholelithiasis are an alternative to extracorporeal shockwave lithotripsy which offer advantages of fewer restrictions on stone size and type as well as avoidance of fragmented stone passage complications. Endoscopic techniques would be facilitated by methods of welding gallbladder tissues. The technical constraints imposed by the endoscopic approach favor nonsuture methods of fusing gallbladder tissues. To evaluate a laser method for fusing biliary tissue, we have compared the healing response of laser-welded versus polyglycolic acid suture-closed incisions in canine gallbladder tissue in vivo. The laser used was a thulium-holmium-chromium:YAG laser producing 200-microsecond, 300-millijoule pulses at 2.15 microns. Serial sacrifice of dogs that underwent laser or suture closure of incisions made in the fundus of the gallbladder revealed that all repairs healed without evidence of leakage or infection. Laser-welded cholecystotomy sites had complete fibrous healing of the wound by two weeks postoperatively and reepithelialization by three weeks after operation. Suture-closed wounds were still without complete epithelization four weeks after the procedure. Laser welding may be a useful technique in endoscopic biliary surgery.

Animals↗
PubMed1996

The influence of surgical technique on clinical outcome of laparoscopic Nissen fundoplication.

BACKGROUND: During laparoscopic Nissen fundoplication (LNF), it is unclear whether the short gastric vessels (SGV) should be divided, the crura reapproximated, or the wrap sutured to the crus. METHODS: Since first performing LNF, we have consistently utilized a <2.5-cm wrap performed over a >50 Fr dilator. Other technical details have varied, and these are reviewed in terms of early clinical outcome. Of 105 consecutive patients undergoing LNF, two were converted to open operation (2%). In the remaining 103 patients with >/=3-month follow-up (mean 17 months), the initial 46 (group 1; 45%, mean age +/- SEM = 47 +/- 2 years) had selective division of the SGV, crural closure, and wrap fixation. In this group, 32 patients (70%) underwent SGV division, 30 patients (65%) had crural closure (10 anteriorly/20 posteriorly), and 14 patients (30%) had the wrap sutured to the crus. During the subsequent 57 LNFs (group 2; 55%, 47 +/- 2 years), all patients underwent SGV division, posterior crural closure, and suture of the wrap to the crus. RESULTS: Clinical outcome at >/=3 months was compared between the two groups. The frequencies of mild reflux symptoms, meteorism, and persistent dysphagia were similar in the two groups. However, the incidences of slippage of the wrap into the chest and the need for secondary intervention (esophageal dilatation and/or laparoscopic reoperation) decreased significantly from 15% and 13% of patients in group 1, respectively, to no occurrences in group II. Chi-square analyses revealed that combinations of these technical variables were significantly related to the improved outcome in group II. CONCLUSION: Based on these data demonstrating improved clinical outcome, we recommend routine division of the SGV, posterior closure of the crura, and fixation of the wrap to the crus during LNF.

Adolescent↗
PubMed1982

[Hypoglossofacial anastomosis, results in 19 cases].

Hypoglossofacial anastomoses was performed in 19 patients, in the majority of cases for tumors located in the pontocerebellar angle. Results were a total success in 16 cases, one patient has not been seen again, and operation had been performed too recently to assess results in two cases. Anastomosis was conducted during initial surgery in 12 cases, and at a later stage in the other 7. In one patient, anastomosis 3 years after facial paralysis following excision of an acoustic nerve neuroma resulted in satisfactory re-innervation of the face after 13 months. Results were not significantly different in 6 patients with an intramastoid anastomosis and in 13 where it was performed in the parotid region. In 11 cases, a classical anastomosis was performed, involving suture of the XIIth and VIIth nerve trunks (type I anastomosis). A more complex procedure in the remaining 8 cases involved separate anastomosis of the XIIth and facial nerve branches, with, in some patients, implantation of sternothyroid muscle fragments, supplied by the descending branch of XII, into the orbicularis muscle. Results were good using these modifications, but valid comparison with those following classical methods cannot be made at the present time. Technical features of the procedure employed are described. Hypoglossofacial anastomosis is currently the only method giving satisfactory constant results when end-to-end suturing of the facial nerve or a superficial cervival plexus graft is obligatory.

Cerebellar Neoplasms↗
PubMed2000

Cervical hemilaminectomy reconstruction: technical note.

STUDY DESIGN: A technique for posterior cervical hemilaminectomy reconstruction is described. OBJECTIVE: To describe a technique for reconstruction of cervical hemilaminae in an adult that resulted in osseous fusion and to suggest modifications for use in children. SUMMARY OF BACKGROUND DATA: Although uncommon, cervical hemilaminectomy can result in spine deformity. Re-establishment of the osseous and ligamentous structures should minimize this problem. METHOD: After excision of an intraspinal neurenteric cyst, removed cervical hemilaminae at C2 and C3 were reconstructed with metal plates, and posterior ligaments were reapproximated with suture. RESULTS: Radiologic evidence of osseous fusion was present at 1 year after surgery. CONCLUSIONS: The advantages of this technique are restoration of normal anatomy, technical ease, and simplicity. A modification of this technique in children by using absorbable rather than metal plates should allow for normal spine growth.

Adult↗
PubMed2003

Effect of suture size and carotid clip application upon blood flow and infarct volume after permanent and temporary middle cerebral artery occlusion in mice.

Problems with the intraluminal suture method for induction of focal cerebral ischemia in genetically altered mice include occurrence of subarachnoid hemorrhage (SAH) and variability of infarct volume. We hypothesized that use of 5-0 curved or 6-0 straight suture for carotid cannulation might decrease SAH and that the application of a microvascular clip to the common carotid artery (CCA) might decrease variability of infarct volume. The purpose of this study is to evaluate and explain the results of these technical modifications. Strain related differences in vascular anatomy were evaluated. Male C57BL/6 mice were divided into two groups for permanent and temporary middle cerebral artery occlusion (MCAO). Results of 5-0 curved suture and 6-0 straight suture insertion with and without CCA clip application were examined. Cerebral perfusion was monitored by laser-Doppler flowmetry and infarct volume was measured. After permanent MCAO, larger and more consistent infarct volumes resulted using CCA clip application with a 6-0 but not with a 5-0 suture. After temporary MCAO, the SAH rate was 12.5% with a 5-0 curved suture and 11.1% with a 6-0 straight suture. A 40% rate was observed in a pilot study with 5-0 straight suture. Infarct volume after temporary MCAO with a CCA clip was significantly larger and variability of infarct volume was smaller than without the CCA clip using 5-0 curved and 6-0 straight suture. In summary, SAH is less frequent using a 5-0 curved or 6-0 straight suture. Infarct volume is enlarged by application of a CCA clip (249).

Animals↗
PubMed2000

In situ vaginal wall sling.

INTRODUCTION: Recent reviews have noted failures of transvaginal surgical procedures designed to cure female stress urinary incontinence (SUI). Slings for SUI appear to sustain continence over time but have been reserved for the more complex cases of intrinsic sphincteric deficiency because of the perception by many surgeons of increased technical difficulty and complication rates. However, this very success in complex cases of SUI bespeaks the need to develop modifications to simplify sling surgery so as to encourage sling use in all women with SUI. Modifications continue to be applied, including anchoring the supporting sutures to the pelvic bones and reducing the transvaginal dissection to prevent further prolapse. I review the use of the in situ anterior vaginal wall sling using bone anchoring techniques with preservation of the endopelvic fascia. TECHNICAL CONSIDERATIONS: The in situ sling is performed with the patient in the dorsal lithotomy position under regional or general anesthesia, with a 16F Foley catheter placed in the bladder and a weighted vaginal speculum on the posterior vaginal wall. An anterior vaginal suburethral patch is supported by nonabsorbable sutures anchored to the pubic bone. CONCLUSIONS: The use of bone anchoring techniques with preservation of the endopelvic fascia appears to enhance the success rate of autologous vaginal wall slings without increasing the risk to the patient and, as minimally invasive procedures, these techniques appear to reduce surgical time and length of hospitalization, thus reducing costs.

Female↗
PubMed2006

Easyloop knot: a simple and safe extracorporeal knot.

Thorough knowledge of laparoscopic suturing is of great importance to the laparoscopic surgeon, especially during the performance of advanced laparoscopic procedures. Intracorporeal and extracorporeal knot tying enhances the technical capabilities of the laparoscopic access, thus extending the spectrum of laparoscopic procedures to that of open surgery. We describe herein a new extracorporeal knot designed with an emphasis on simplicity and safety.

Humans↗
PubMed2004

Modified inside-out technique for meniscal repair.

A modified technique of the inside-out suture for arthroscopic repair of meniscus is described. Although the conventional inside-out technique is a fine modality of a meniscal repair, it is difficult to perform vertical suture and to attain good coaptation and strong fixation. We introduce a modified inside-out suture, which uses a suture hook, a zone-specific cannula, and a specially designed looped needle for an efficient meniscal repair. The modified inside-out suture technique provides vertically oriented suture, excellent tissue coaptation, and firm fixation. We recommend this technique as an excellent method for repairing a tear in most parts of the meniscus, especially the posteromedial corner.

Arthroscopy↗
PubMed2004

A simplified arthroscopic outside-in meniscus repair technique.

A simple and reproducible technique for meniscus tear repair is described. The technique requires the use of a 16-gauge intravenous catheter, a suture hook, and a knot pusher. The catheter is used for perforation of the meniscus and the tear site in two adjacent locations, then the two free suture ends are retrieved and passed along a small arthroscopic cannula placed at the ipsilateral joint space, and finally a sliding arthroscopic knot is tied and advanced to the meniscus surface with a knot pusher. This simple technique provides secure fixation of the meniscus tear during the healing period and has been proven successful and without complications in the patients in whom it has been used.

Adult↗
PubMed2004

Arthroscopic-assisted biceps tenodesis for ruptures of the long head of biceps brachii: The cobra procedure.

A number of open procedures have been presented in the literature that described the repair of the ruptured long head of biceps brachii (LHBB). Although arthroscopic biceps tenodesis techniques have been used to address partial tears or subluxation of the biceps, no arthroscopic technique to assist in the treatment of complete retracted ruptures of the LHBB has been described. This article describes an arthroscopic-assisted biceps tenodesis, using interference screw fixation, in the treatment of acute or chronic LHBB ruptures. An arthroscopic-assisted biceps tenodesis with interference screw fixation provides an alternative to open LHBB tenodesis. The ability to tenodese the retracted LHBB arthroscopically is a technologic advance that could reduce morbidity in comparison to open tenodesis, thus resulting in a better functional outcome.

Absorbable Implants↗
PubMed2006

How to clamp the main pulmonary artery during video-assisted thoracoscopic surgery lobectomy.

We sometimes run across difficulty in dissection of the pulmonary arteries due to dense pleural adhesions and bleeding from the pulmonary artery during the video-assisted thoracoscopic surgery (VATS) lobectomy. In these cases, conversion of the VATS approach to open thoracotomy is a requisite. The presence of an easy and safe technique for pulmonary artery clamping will make the switch of the surgical procedure unnecessary. We developed the new technique for pulmonary artery clamping using 1-0 silk suture. This may become one of the standard techniques for pulmonary artery clamping not only in VATS but also in open thoracotomy, as well.

Constriction↗

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