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At least 1,207 records · Page 67Linked to original sources
PubMed2001

Simple technique for proper approximation and closure of peritoneal and rectus sheath defects at port site after laparoscopic surgery.

Complex intra-abdominal surgical procedures can now be performed with laparoscopy, and laparoscopic cholecystectomy has become the gold standard in the care of patients with cholelithiasis. This and other surgically challenging procedures involve use of multiple large (10-mm-15-mm) ports. A standard laparoscopic cholecystectomy employs two 10-mm trocar incisions. Development of incisional hernia from these port sites is well recognized unless the rectus sheath is closed properly. This makes proper closure of the incisions for larger ports critical, especially 10-mm to 15-mm ports. However, securing abdominal wall bleeding and closing facial defects through a small incision can be a cumbersome task. We have developed a simple technique using the regular curved needle and sutures for closure of rectus sheath defects through a small port-site incision.

Adolescent↗
PubMed2006

Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses.

The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

Anastomosis, Surgical↗
PubMed2001

[How safe is intracorporeal anastomosis?].

A recent German multi-centre study comprising 3070 laparoscopic colorectal resections indicates that complete intracorporeal anastomoses are done in only 1.8%. In agreement with the literature, technically demanding hand-sutured anastomoses are no common practice either. Intracorporeal anastomosis is usually done using endoscopic linear stapling devices or the conventional circular stapler by performing end-to-end, end-to-side, and side-to-side anastomoses. These techniques are more frequently used in the upper than in the lower gastrointestinal tract. The date published so far, however, indicate that the complete intracorporeal anastomosis is a save technique in the hands of laparoscopically experienced surgical teams. This technique has very low rates of postoperative stenoses (0-10%) and, furthermore, very low rates of postoperative anastomotic leakages (0-8%).

Anastomosis, Surgical↗
PubMed2002

A modified infarct exclusion technique for a post-infarction ventricular septal defect.

BACKGROUND: Operative mortality for a post-infarction ventricular septal defect (VSD) remains high. The infarct exclusion technique has been producing a favorable outcome for repairing this serious defect. However, there is the technical weakness, namely running suture along the base of the necrotic septum. We sutured a pericardial patch using multiple interrupted mattress sutures in such a manner as to exclude the infarct and VSD. METHODS: Over the past seven years, nine consecutive patients with a post-infarction VSD underwent an early repair in the same manner. The VSD was anterior in eight patients and posterior in one. We sutured a xenopericardial patch to the healthy myocardium around the infarct using interrupted mattress sutures instead of running sutures as the infarct exclusion technique. In addition, on the postero-inferior margin of the patch, one or two mattress sutures passing through the full thickness of the anterior papillary muscle were used. RESULTS: Only one patient died of pneumonia 50 days after surgery. The other eight patients were followed up and were functionally classified as NYHA class I or II. CONCLUSIONS: These findings suggest that our modified infarct exclusion technique using multiple mattress sutures is an effective alternative surgical technique.

Aged↗
PubMed1981

[Microsurgical education].

Equipment and organization of an experimental microsurgical laboratory in a plastic and reconstructive surgery unit of a large size central hospital (Kantonsspital Aarau, Switzerland) are described. A specially trained technician supervises the laboratory and demonstrates technical details of microsurgical sutures to beginners. In addition to clinical work such regular laboratory training is important for all residents.

Curriculum↗
PubMed1978

[Differential diagnosis of cancer recurrence and cicatrical stricture of esophageal anastomosis].

A careful analysis was made of the causes, terms of occurrence and course of cancer recurrence in the area of gastrointestinal and gastroesophageal anastomoses after 498 gastrectomies, resections of the cardia and esophagus for cancer. The possibility of the differential diagnosis between the recurrence and cicatricial strictures of esophageal anastomoses is shown. Based on the clinico-roentgenological data etiopathogenetically 3 variants of cicatricial strictures were singled out: a) due to technical errors, inadequate anastomotic sutures and fistulas; b) due to grave anastomositis, and c) due to reflux-esophagitis. Among cancer recurrences at the site of esophageal anastomosis three forms were differentiated, depending on the origin of recurrence and a form of tumor growth: exophitic, endophitic and paraesophageal recurrence. Special attention is given to an early recurrence and the development of it against the background of pre-existing cicatricial stricture of the anastomosis.

Adult↗
PubMed1995

[Pseudoaneurysms after carotid endarterectomy].

Pseudoaneurysms after TEA of the internal carotid artery are one of the rarest and most severe complications of this form of surgery. Their etiology appears to depend on 3 causes: a suturing defect due to technical errors made by the surgeon or to the incorrect choice of threads; an infections, and lastly the arterial wall weakened by TEA. The patch increases the risk of false aneurysm approximately four fold. We therefore agree with other authors that, in spite of the undoubted value of the patch in the prevention of restenosis, it must only be used in the presence of an internal carotid of small diameter (less than 4 mm). Contrary to what is reported in the literature we performed both these operations under loco-regional anesthesia and a detailed knowledge of this method allows is to be performed on the carotid axis. Only through a careful follow-up of all the carotids operated can the small dilations which often do not require surgical treatmente identified. The two cases reported here were treated by the removal of the pseudoaneurysms and its replacement with a prosthesis in one case and with the vena saphena in the other. Both were monitored with clinical examination and echo-Doppler and no recidivation has been reported to date.

Aneurysm↗
PubMedDate not supplied

[Duodeno-colic fistula due to cancer of the right colon].

The author presents a case of duodeno-colic fistula revealing carcinoma of the right hepatic flexure showing the difficulty of surgery. A right hemi-colectomy enlarged to the duodenum and pancreas is the ideal operation from a curative point of view, but rarely possible owing to the age of the patient and the constitutional background. The risk of breakdown of duodenal sutures, which is sometimes technically difficult after colonic removal, is far from negligible. The results of by-pass operations, with or without exclusion of the fistula, are poor and uncertain.

Adenocarcinoma↗
PubMedDate not supplied

[Treatment of injuries of the duodenum and pancreas].

The authors study 84 patients that had damages of the duodenum and or pancreas and underwent different types of surgery. In 39 patients who had damage only in the duodenum; there were 2 (4.0%) duodenal fistulas, and 3 (6.0%) intraperitoneal abscess. In 38 patients who had injuries only in the pancreas; there were 6 (13.1%) acute pancreatities, pancreatic fistulas and 1 (2.2%) pancreatic pseudocyst. In 7 cases, injuries were found to both pancreas and duodenum. The author reports 1 case of duodenal fistula (14.3%) 1 case of acute pancreatitis (14.3%) and 3 cases of pancreatic fistula (43.0%). Only 7 patients died (8.3%), and of these 2 died for reasons not directly related to the operatory technic used. A simple suture can be performed in those cases where a complete section of the duodenum is unnecessary and there is no injury to the duodenal papilla. A burying suture of the stomas associated with a side-to-side duodenojejunal anastomosis should be preferred in the complete section of the duodenum localized beyond the ampulla of Vater. In all superficial wounds of small extension a suture of the pancreas should be performed. Distal pancreatectomy of body or tail should be made in the wounds with a possible lesion to the Wirsung duct and when there is an extensive glandular lesion. The associate wounds of duodenum and pancreas should be treated as if they were isolated lesions.

Abdominal Injuries↗
PubMed2005

Simplify the technique of nasoenteric feeding tube placement with a modified suture tie.

Endoscopic placement of nasoenteric feeding tubes is a common technique used in clinical practice. However, use of the endoscopic "drag and pull" method to pull the tube into position by grasping the feeding tube with a biopsy forceps requires considerable skill. In this paper, we describe a modified suture, which markedly diminishes the technical difficulty for nasoenteric feeding tube placement. Patients admitted to the intensive care unit, with evidence of impaired gastric emptying, referred for placement of a nasoenteric tube, were included in this study. A modification of the feeding tube was made by securing two strands of nylon suture to the tip of a 12-Fr feeding tube. Three knots were made along the sutures on both sides. The feeding tube was introduced through the nose and passed into the stomach. Then, placement of the nasoenteric tube was attempted by an endoscopic "drag and pull" method. Eighty-six patients (49% male, mean age of 60 years) underwent 94 procedures for attempted nasoenteric feeding tube placement. Feeding tubes were placed successfully in 91 of 94 (97%) procedures in these patients. The procedures required an average time of range 5 to 14 minutes, and no major complications were incurred. These results indicate that a modified suture tied to the tip of a nasoenteric feeding tube reduces the technical difficulty of the procedure and facilitates rapid successful placement into the small bowel.

Adult↗
PubMed2005

[Microsurgery: History of instrumental vascular anastomoses, our experience with eversion-stapling using VCS forceps].

One century, after Carrel in 1906, technics of vascular surgery are the same. After two world wars, peace surgery has been improved by war surgery. Microscopy surgery gave a new way for vascular surgery which became microsurgery with specific instrumentation. We have move from the developing period of microsurgery in the 1970s, to the fully matured period of microsurgery in the 1980s and the the development of clinical free flaps. The 1990s must be the turning point from autogenous tissue transplantation to allogenic transplantation. Ethic comity keeps keys of future! About microvascular anastomoses, many instrumental technics are explored but no-one is better than the classic manual suture. For us, the best instrumental technic is the anastomose with titanium clips VCS((R)) but we only use it in good situation without difficulties.

Adult↗
PubMedDate not supplied

Multivectored suture suspension: a minimally invasive technique for reanimation of the paralyzed face.

BACKGROUND: Despite advanced techniques for reanimation of the lower face, many patients opt for static suspension procedures, which are less invasive and have a relatively short recovery period. However, even static suspension procedures require general anesthesia, overnight hospital stay, and significant soft tissue manipulation. We present a minimally invasive technique, the multivectored suture suspension, which addresses these drawbacks. OBJECTIVES: To study the technical feasibility and efficacy of the multivectored suture suspension technique in the paralyzed face. DESIGN: The study was carried out prospectively in 12 patients with House-Brackmann grade 6 facial paralysis. Nine patients presented within 6 months of tumor resection and 3 patients presented more than 1 year after surgery. MAIN OUTCOME MEASURES: The parameters evaluated were (1). restoration of nasal breathing; (2). improvement of drooling; (3). restoration of normal speech; (4). cosmetic results; and (5). total surgical time. RESULTS: With an average follow-up of 14 months, patient evaluation of the outcome parameters was as follows: (1). 10 patients (83%) reported significant and 2 (17%) reported moderate restoration of nasal breathing; (2). 10 patients (83%) reported significant improvement and 2 (17%) reported modest drooling improvement; (3). 8 patients (66%) reported significant improvement and 4 (34%) reported modest improvement of speech; (4). 9 patients (75%) reported complete satisfaction and 3 (25%) reported moderate satisfaction with cosmesis. The average surgical time was 46 minutes. Three revisions were required for suture failure. CONCLUSIONS: The multivectored suture suspension technique is a minimally invasive, reversible method of lower facial reanimation that provides improved cosmesis with restoration of nasal breathing. It can be performed under local anesthesia in an outpatient setting, thereby reducing morbidity and cost.

Aged↗
PubMedDate not supplied

Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up.

We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2-year follow-up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side-to-side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open-mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco-humeral ligament, were performed arthroscopically as needed. All repairs were performed using O-PDS or 1-PDS suture and a 7-mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (< 30 points) results. We have seen intraoperative but no cases of postoperative anchor pullout. The simple sutures performed as well as, and in some ways better than, mattress configurations. All fair and good results were with O-PDS. To perform an arthroscopic repair, the tear must be well visualized and mobilizable back to the tuberosity with only moderate tension. The anterolateral operative portal has been very useful because it allows better angle of entry for instruments and anchors and improved visualization in the subacromial space. The use of PDS and simple suture configurations has made the repair technically easier to perform with the instruments that are currently available. We do recommend 1-PDS suture because it breaks less easily even though it is slightly more difficult to deliver and tie. Arthroscopic cuff mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.

Adult↗