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PubMed1980

[Experience with the EEA stapler in colon anastomosis].

On the basis of 35 resections of the sigma of low anterior resections of the rectum, the outcome of conventional (13) and EEA stapler (22) anastomoses is analysed. The incidence of clinical or radiological insufficiencies is significantly lower in stapler anastomoses. Technical details important for a successful stapling procedure and the outcome of the anastomosis are discussed. The importance of the control for completeness of the tissue rings after removal of the purse-string suture is stressed. Regarding these technical details stapler anastomoses have proven to facilitate very low anterior rectal resections and to achieve less postoperative complications.

Aged↗
PubMed1985

Heat welding for surgical sutures.

The purpose of this experimental study was to test the potential value of heat welding to cut the ends of knotted surgical sutures. This heat process resulted in knot security in a coated polyglactin suture with fewer throws than those needed for the same suture with knotted ends cut by scissors. Results of mechanical performance testing of the knotted sutures cut either by scissors or welding did not differ significantly. With refinements in the technical design of the heat source, suture welding may have important applications in surgery.

Hot Temperature↗
PubMed2005

Myotomy length determinants in endoscopic staple-assisted esophagodiverticulostomy for small Zenker's diverticula.

A small Zenker's pouch is a major challenge for endoscopic staple-assisted esophagodiverticulostomy (ESED). This study tested the stapler dimensions so as to identify limitations they impose on ESED. Combining ESED with additional endoscopic suturing could extend the incision and consequently the myotomy. Zenker's diverticulum residual pouch measurements were performed with a previously reported latex glove model and in patients undergoing surgery. Two stapler designs were compared by measuring the residual pouch length for both the stock and modified staplers. One other stapler model cannot be modified without damaging the mechanism. The Endostitch was used to place an additional suture at the apex of the staple line, allowing cutting between the staples while leaving a closed distal incision. All three staplers suitable for ESED leave a residual pouch of 1.5 cm when unmodified. The modified anvil staplers gave a smaller residual pouch by 4 to 5 mm. An additional septal reduction can be accomplished by suturing the area distal to the staple line and incising the party wall beyond the stapler cut. The absolute amount of residual pouch with an additional myotomy is 3 mm. The combined staple-suture technique has proven relatively safe thus far. To provide a maximally efficient myotomy in a patient with a short pouch, the surgeon needs to be aware of the stapler differences. Modifications of the staplers may decrease the depth of the residual pouch, but may carry an added liability. A minimum residual pouch can be achieved with a combination of stapler and suture techniques, but is more technically demanding than the original ESED description.

Digestive System Surgical Procedures↗
PubMed1999

Modern concepts in arthroscopic Bankart repair.

The purpose of this report is to review recent advances in Bankart repair that allow it to be performed arthroscopically. Metallic implants in the form of staples, screws, or rivets were used initially, but problems with loosening of implants has prompted development of alternative devices and techniques. A modified form of the transglenoid suturing technique used in open Bankart repair has been used successfully but is associated with an increased risk of soft tissue complications. The use of absorbable tacks avoids some of the complications associated with this approach, but the ability to advance the capsule to reduce the volume is limited. Recently, the use of suture anchors has been described for arthroscopic Bankart lesion repair. However, the ability of these anchoring systems to advance and reduce the capsular volume is limited, and the arthroscopic techniques are technically demanding. One particularly innovative suture anchor system uses a bioabsorbable suture anchor with an integrated suture passing system. This self-contained implant allows multiple passes with suture through the capsule, followed by attachment to the glenoid with the bioabsorbable anchor. This procedure allows the capsule to be advanced by passing suture through before it is anchored to the glenoid, thereby reducing capsular volume to help restore shoulder stability.

Arthroscopy↗
PubMed2003

A new technique of laparoscopic ovariopexy before irradiation.

OBJECTIVE: To report a new technique of laparoscopic ovarian transposition to preserve ovarian function in women who require pelvic irradiation for musculoaponeurotic fibromatosis (extra abdominal desmoid). DESIGN: Case report. SETTING: University teaching hospital. PATIENT(S): Two nulliparous women who required adjunctive radiotherapy for musculoaponeurotic fibromatosis where radiotherapy planning indicated that the right ovary could be removed from the field of radiation by anterior transposition. INTERVENTION(S): Laparoscopic suturing of the right ovary to the right round ligament with intracorporeal polypropylene sutures. MAIN OUTCOME MEASURE(S): Technical feasibility, recovery, postoperative adhesions, ease of ovarian repositioning, and evidence of ovulation after completion of radiotherapy. RESULT(S): The technique was easily performed without needing to divide the ligament of the ovary. Recovery was rapid, and there were no postoperative adhesions. The ovary showed evidence of continued function and was easily repositioned by dividing the sutures. CONCLUSION(S): In selected cases, this method of ovarian transposition has the advantages not only of being technically easy but also of allowing for repositioning of the ovary with minimal disruption of its anatomical relationship to the fallopian tube, thereby favoring fertility.

Adult↗
PubMed1975

[Ruptures of the extensor mechanism of the knee joint (author's transl)].

Ruptures of the quadriceps tendon and patellar ligament are rare among injuries of the extensor mechanism of the knee when compared to fractures of the patella. 39 cases of which 31 were re-examined are being discussed with regard to therapy and results. According to our findings, ruptures of the extensor mechanism are not exclusively an injury of higher age groups. Predisposing factors for ruptures of the quadriceps tendon and patellar ligament are preexisting disease or posttraumatic sequelae. Fresh or old injuries require different operative technics. Usually, fresh ruptures can be repaired by end-to-end sutures. Old injuries require plastic procedures. Different technics are being described. Postoperatively, cast fixation is mandatory. The post-operative period of remobilisation is largely depend upon preexisting degenerative joint changes as are the post-operative results. A significant increase in post-operative osteoarthritis did not occur. Early degenerative changes in the femoro-patellar joint as seen on tangential views by the Settegast technic lead to the conclusion that the operative reconstruction does not always take into consideration the biomechanics of the femoro-patellar articulation. Immediate operative reconstruction of the ruptured extensor mechanism of the knee joint seems mandatory.

Adolescent↗
PubMed1976

[Tactical and technical errors as the cause of development of external intestinal fistulas].

An analysis of causes of the development of external enteric fistulas in 71 patients, who to the moment of surgery showed no purulent-inflammatory processes in the abdomen, has demonstrated that in most patients (40 persons) the fistula development can be related with technical errors (an injury, deserosing, suturing of the intestine) during an operation. It is believed that for prophylaxis of enteric fistulas a special care should be given by a surgeon to mobilization of the intestine from adhesions, strict observation of technical recommendations and tactical purposes pertaining to treatment of acute intestinal obstruction, strangulated hernias, etc.

Appendicitis↗
PubMedDate not supplied

Technical considerations in knot construction. Part I. Continuous percutaneous and dermal suture closure.

The purpose of this investigation was to determine the security of the square knot tied with one looped end and one free end versus the security of the square knot tied with two free ends. Size 4/0 and size 6/0 monofilament nylon, polypropylene, and Biosyn sutures were selected for this evaluation. The mechanical performance of these sutures was judged according to knot breakage force and number of throws required to attain security. Knots with one looped end and one free end require more throws to ensure knot security than do knots constructed from two single suture strands of comparable sizes and types of sutures.

Caprolactam↗
PubMed1977

[Methods of anastomosis in anterior resection of the rectum].

For the second row of anastomosis sutures in anterior resection the authors employed the technic of "enlarging rectosigmoid anastomosis", which is formed by two running sutures. The second row of sutures is put prior to the withdrawal of the apparatus KTs-28, which is used for pulling the stoma into the wound and turning of both anastomosed intestines to provide an adequate access to the anastomotic line. The experience with the initial II operations seems to be fairly promising. No stricture of the anastomosis develops while using this technic. Indications to the anterior resection of the rectum for cancer are discussed.

Humans↗
PubMed2003

Hellström technique revisited: laparoscopic management of ureteropelvic junction obstruction.

OBJECTIVES: To present our experience with the treatment of adult ureteropelvic junction (UPJ) obstruction using a laparoscopic Hellström vascular relocation technique. METHODS: Transperitoneal laparoscopy was performed in 35 patients for the management of UPJ obstruction. In 9 cases, we identified crossing lower pole vessels and performed the Hellström technique. We discuss our indications, intraoperative techniques, and outcomes when performing only vascular relocation in these patients. RESULTS: All 9 patients presented with long-standing flank pain and were identified as having UPJ obstruction (7 primary, 2 secondary) on radiographic imaging. The intraoperative decision to perform the Hellström technique was based on the presence of the crossing vessels, a grossly normal appearance of the ureter and UPJ, and a small renal pelvis. The crossing vessels were completely mobilized, displaced cephalad, and fixed using intracorporeal sutures. The mean operative time and blood loss was 164 minutes and 15 mL, respectively. At a mean follow-up of 19 months (range 14 to 31), the patients were asymptomatic with no evidence of obstruction on Lasix nuclear renography. CONCLUSIONS: Traditional treatment of UPJ obstruction, with or without crossing vessels, has been accomplished by pyeloplasty. Dismembered pyeloplasty is a standard method in cases of associated crossing vessels; however, we propose that the Hellström technique be considered in cases in which the ureter appears normal and the pelvic anatomy is unfavorable for transection and anterior reanastomosis of the ureter and pelvis. These considerations are particularly relevant during the laparoscopic approach in which intracorporeal suturing and knot tying are technically challenging.

Adolescent↗
PubMed1997

[Development and pathophysiology of abdominal wall defects].

Repair of abdominal wall hernias is the most frequently performed operation in surgery. Primary hernias arise at anatomical weak points; incisional hernias result from laparotomies. As the fascia heals slowly, the suture should be strong enough to withstand the intraabdominal pressure. Complications in wound healing may lead to a hernia, especially when absorbable sutures have been used. The rate of incisional hernias is technically influenced by the type of incision, the suture technique, and the suture material. To achieve adequate repair it is often necessary to change the principles of abdominal wall closure, for example by using alloplastic material. The meshes reinforce the architecture of the abdominal wall both by pure mechanical means and by induction of a stable scar formation (polypropylene, polyester).

Abdominal Muscles↗
PubMed1996

Vascular applications of telepresence surgery: initial feasibility studies in swine.

PURPOSE: Telepresence surgery is a novel technology that will allow procedures to be performed on a patient at locations that are physically remote from the operating surgeon. This new method provides the sensory illusion that the surgeon's hands are in direct contact with the patient. We studied the feasibility of the use of telepresence surgery to perform basic operations in vascular surgery, including tissue dissection, vessel manipulation, and suturing. METHODS: A prototype telepresence surgery system with bimanual force-reflective manipulators, interchangeable surgical instruments, and stereoscopic video input was used. Arteriotomies created ex vivo in segments of bovine aortae or in vivo in femoral arteries of anesthetized swine were closed with telepresence surgery or by conventional techniques. Time required, technical quality (patency, integrity of suture line), and subjective difficulty were compared for the two methods. RESULTS: All attempted procedures were successfully completed with telepresence surgery. Arteriotomy closures were completed in 192+/-24 sec with conventional techniques and 483+/-118 sec with telepresence surgery, but the precision attained with telepresence surgery was equal to that of conventional techniques. Telepresence surgery was described as intuitive and natural by the surgeons who used the system. CONCLUSIONS: Blood-vessel manipulation and suturing with telepresence surgery are feasible. Further instrument development (to increase degrees of freedom) is required to achieve operating times comparable to conventional open surgery, but the system has great potential to extend the expertise of vascular surgeons to locations where specialty care is currently unavailable.

Animals↗
PubMed1978

[Cesostoma in tumors of the large intestine and a method for its closure].

Cecostomy is found to prevent effectively suture incompetency of entero-entero-anastomosis in intraabdominal resections in the large intestine in obese patients suffering diabetes and also in aged patients. The method of closing the cecostoma described may be also recommended for elimination of parietal fistulas constructed in other portions of the large intestine. Taking into account a simple technic of closure, using mechanic suture, the availability of suturing apparatuses in many hospitals, it may be recommended for a wide practical use.

Cecum↗
PubMed2003

Coronary anastomotic devices: blood-exposed non-intimal surface and coronary wall stress.

OBJECTIVE: This study compares the area of blood-exposed non-intimal surface in device-constructed anastomoses with the conventionally sutured anastomosis and examines the technical feasibility of 0 blood-exposed non-intimal surface anastomosis configurations. METHODS: In the device-constructed anastomosis, blood-exposed non-intimal surface was estimated in all anastomosis configurations identified in truly new (ie, nonduplicate and nonrelated) patent applications and in anastomotic devices recently introduced by several institutions. In the sutured anastomosis, blood-exposed non-intimal surface area was estimated by analysis of previously investigated anastomoses. In 0 blood-exposed non-intimal surface anastomosis configurations, finite element modeling was used to calculate coronary wall stress. RESULTS: By the end of 2001, 57 truly new applications for the distal coronary anastomosis had been published, categorized in 11 types of anastomosis configurations. The tissue blood-exposed non-intimal surface area (ie, non-intimal tissue surface area) ranged from 0 to 6 mm(2). Approximate total blood-exposed non-intimal surface areas (ie, sum of tissue blood-exposed non-intimal surface and foreign body surface area) in recent devices are 80 mm(2) (GraftConnector, Jomed, Helsingborg, Sweden); 33 mm(2) (Magnetic Vascular Positioner rings, Ventrica, Inc, Fremont, Calif); 4.3 mm(2) (distal connector of St Jude Medical, Inc, St Paul, Minn); and 0.3 mm(2) (Crinoline frame, University Medical Center Utrecht/Delft University of Technology, The Netherlands). The sutured anastomoses, in contrast, contained approximately 1.3 mm(2) blood-exposed non-intimal surface area. The mean peak porcine coronary wall stress in 0 blood-exposed non-intimal surface anastomosis configurations with greater than 90 degrees arteriotomy edge eversion ranges from 0.4 to 0.8 N/mm(2) compared with the mean porcine coronary tear stress of 0.8 N/mm(2). CONCLUSIONS: In recently introduced devices for clinical use, the total blood-exposed non-intimal surface area ranges from 4.3 to 80 mm(2) compared with 1.3 mm(2) in sutured anastomoses. The blood-exposed non-intimal surface area depends on anastomotic orifice size, wall thickness, and bonding components' location and size. Deforming the coronary wall to most of the 0 blood-exposed non-intimal surface anastomosis configurations leads to dangerously high stress concentrations in the coronary arteriotomy corners.

Anastomosis, Surgical↗