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PubMed1982

Iatrogenic myocardial infarction. A possible complication of mitral valve surgery related to anatomical variation of the circumflex coronary artery.

Following mitral valve replacement, a 43-year-old male presented electrocardiographic signs of myocardial ischemia-injury in the postero-inferior wall, and subsequently died. The post mortem examination revealed a subendocardial myocardial infarction in the postero-inferior wall. The myocardial infarction was related to the accidental ligation of the circumflex coronary artery by one of the sutures fixing the prosthetic valve. Technically, this surgical accident can be explained by the anomalous origin and course of the circumflex coronary artery found in this patient at the time of the post mortem examination. Anatomical variations of the coronary arteries and their surgical implications are discussed. This iatrogenic complication could have been avoided by performing a preoperative coronary angiography, which was not done in the reported case for medical reasons.

Adult↗
PubMed2005

Technical modifications for robot-assisted laparoscopic pyeloplasty.

PURPOSE: Laparoscopic pyeloplasty (LP) is gaining acceptance as a standard of care for the repair of ureteropelvic junction (UPJ) obstruction, with results comparable to those of open repair. However, it remains a technically challenging procedure requiring intracorporeal suturing skills. Recent reports have demonstrated equally effective results with robot-assisted laparoscopy with shorter operative times. We present our modified technique for daVinci robot-assisted LP. PATIENTS AND METHODS: From November 2002 to May 2004, 32 consecutive patients underwent LP with the daVinci robotic system for UPJ obstruction. Just prior to laparoscopy, 31 patients underwent retrograde pyelography and cystoscopic placement of a ureteral catheter just distal to the UPJ, which was prepared into the operative field. The remaining patient had an indwelling stent placed preoperatively. Three transperitoneal ports are placed for the robot. A fourth port is placed for retraction, suction, dissection, and suture passage by the bedside surgeon. This port was placed at McBurney's point in the first two patients and the subxiphoid area in the subsequent 30 patients. A ureteral stent was inserted retrograde intraoperatively with laparoscopic assistance after exchanging the ureteral catheter for a guidewire. A Jackson-Pratt drain was placed in all cases. RESULTS: All procedures were completed laparoscopically. Anderson-Hynes dismembered pyeloplasty was performed in 31 patients, while Fengerplasty was performed in 1 patient. The average operative time was 300 minutes (initial 12 procedures: 384 minutes; last 10 procedures: 197 minutes). The average blood loss was approximately 50 mL and the average hospital stay 1.1 days. A crossing vessel was present in 44% of the cases. Stone extraction was performed in 5 cases (23%) and kidney biopsy in 1 case. The only perioperative complications were one migrated stent, which was repositioned under sedation without sequelae and one urinary tract infection. Of the 18 patients with follow-up exceeding 6 months (average 10.3 months), 16 have improved drainage and function and are asymptomatic. One patient with flank pain has no evidence of obstruction. One with delayed, although improved, drainage is asymptomatic. CONCLUSIONS: The daVinci robot system can be used effectively for LP. Although initial operative times were long, there was a significant decrease after the first 12 cases. Having retrograde access to the ureter allows simple intraoperative stent placement. We found that the subxiphoid placement of the fourth port gave the bedside surgeon the optimal location for suction, dissection, and intracorporeal suture passage. This approach and technique have become standard in our treatment of UPJ obstruction.

Adolescent↗
PubMed2002

Laparoscopic surgery for pelvic support defects.

Reconstructive pelvic surgery for the treatment of vaginal prolapse continues to evolve as surgeons continue their quest for definitive surgical cure. Though there are three primary routes of access to reconstructive pelvic surgery (abdominal, vaginal and laparoscopic) it is the laparoscopic approach that appears to be the least utilized. This is in part due to the great degree of technical difficulty associated with laparoscopic suturing. This paper reviews the general principles and functional anatomy associated with normal vaginal support as well as the laparoscopic surgical approach to pelvic floor support defects.

Female↗
PubMed2001

Weight measurement of upper eyelid gold implants for lagophthalmos in facial paralysis.

The use of the gold weight is an established procedure in the treatment of lagophthalmos and usually produces successful results. The critical technical issues are the firm suture fixation to the tarsal plate and the high location of the weight on this plate. However, the estimated weight of the implant from the trials on the skin of the upper lid fails to obtain the expected eye closure outcomes after surgical implantation on the tarsal plate. One of the main reasons could be the different curvature on the skin and on the tarsal plate of the upper eyelid. In this study, the angles between the vertical line and the surface of the outer (skin) and inner (tarsal plate) part of the upper eyelid have been analyzed when the eye is opened and closed. The results show that an addition of 0.2 g to the gold weight estimated in the trial is required to achieve a similar closure of the eye by means of the gold implant on the tarsal plate.

Adolescent↗
PubMed1978

Posterior dislocation of the shoulder: report of six cases.

Posterior dislocation of the shoulder is a rare lesion. We have seen six of these dislocations in recent years. Review of these six cases indicated that posterior dislocations of the shoulder have consistent causes and physical and roentgenographic findings. Recent dislocations can be treated conservatively with closed reduction. Recurrent or unreduced dislocations can be treated successfully with the McLaughlin technic of open reduction and suturing of the subscapularis tendon into the defect in the humeral head. Our results were satisfactory with either closed or open treatment.

Adult↗
PubMed2003

What's new in prolapse surgery?

PURPOSE OF REVIEW: There are very many types of operation for the correction of symptomatic pelvic floor relaxation, and the pelvic surgeon is faced with a difficult task when selecting the most appropriate procedure(s) for an individual patient. Currently, the lifetime risk of undergoing prolapse or continence surgery in France is one in 11; up to 30% of patients will require repeat prolapse surgery, and 10% will require repeat continence surgery. Reconstructive pelvic surgery for the treatment of vaginal prolapse continues to evolve as surgeons continue their quest for a definitive surgical cure. This review looks at the etiology, presentation and current surgical management of genital prolapse in females. RECENT FINDINGS: There are three primary routes of access in reconstructive pelvic surgery (abdominal, vaginal and laparoscopic) for the repair of anterior, superior and posterior defects; the choice often depends on the surgeon's experience. Of the abdominal repairs, abdominal sacrocolpopexy with mesh remains the 'gold standard'; the retropubic paravaginal repair and laparoscopic techniques have not gained widespread acceptance. The laparoscopic approach appears to be the least utilized, because of the great degree of technical difficulty associated with laparoscopic suturing. Of the vaginal restorative procedures, uterosacral ligament vault suspension and iliococcygeous and sacrospinous fixation have their proponents. However, there is increasing interest in the use of biological prostheses (allografts/xenografts) and synthetic absorbable meshes. SUMMARY: Randomized controlled trials are required to evaluate the role of surgical procedures in reconstructive surgery, to determine which type of prosthesis is most suitable.

Female↗
PubMed2005

Management of gastroesophageal reflux disease: medications, surgery, or endoscopic therapy? (Current status and trends).

Gastroesophageal reflux disease (GERD) is a common chronic disorder in the Western world. The basic cause of GERD has been well characterized--the fundamental defect is a loss of integrity of the gastroesophageal barrier. What is less clear is the most appropriate means of addressing this reflux. GERD has a variety of symptoms, ranging from typical presentations of heartburn and regurgitation (without esophagitis) to atypical presentations, such as severe erosive esophagitis and its associated complications. Because of its symptomatic diversity, physicians may select from a variety of therapeutic approaches. Medical therapy aims at decreasing acidity by suppressing proton secretion and has been well established. Available medications include antacids and alginates, H2-receptor antagonists, motility agents, and proton pump inhibitors (PPIs). Antireflux surgery, commonly performed laparoscopically, aims at reinforcing and repairing the defective barrier through plication of the gastric fundus. The earliest performed successful procedures were the Nissen and Toupet fundoplications, to which several modifications have since been made. It has been demonstrated in preliminary studies and long-term outcomes of such open surgery and preliminary studies of such laparoscopic surgery that antireflux surgery is an effective approach, with overall outcomes superior to those achieved with medications. The precise indications for the surgical treatment of patients with GERD, however, remain controversial. In recent years, endoscopic intraluminal antireflux approaches have attracted the attention of physicians, surgeons, and commercial companies, especially after the approval of two endoscopic intraluminal methods by the United States FDA in 2000. The common element is prevention of acid reflux by construction of a functional or controlled barrier in the lower esophageal sphincter zone. Three main methods are currently employed: endoscopic intraluminal valvuloplasty, endoscopic radiofrequency therapy, and endoscopic injection or implantation of foreign material. The endoluminal suturing method is highly demanding technically, and its short-term results are encouraging, although largely dependent on the experience of the endoscopist. Several prospective cohort studies have shown that the radiofrequency procedure (Stretta) significantly improves GERD symptoms and quality of life while reducing esophageal acid exposure and eliminating the need for antisecretory medications in the majority of patients within 6-12 months. Most recently, some researchers have studied the endoluminal implantation of polymers, such as Plexiglas (polymethyl-methylacrylate), Gatekeeper hydrogel, and Enteryx (ethylene vinyl alcohol copolymer). The preliminary results of these studies showed that the implantation method was feasible and safe; however, the only multicenter trial related to outcome that has been published has included just 1 year of follow-up. Here, we review the treatment of GERD: medical, surgical, and endoscopic. In addition, we provide an algorithm based on symptoms and response to treatment for management of these patients.

Algorithms↗
PubMed1992

[Non-malignant esophagotracheal fistulas in adults. Experience with 35 cases].

Esophagotracheal fistula always constitutes a serious, life-threatening complication. Fistulae occurring during medical intensive care with mechanical ventilation are currently the most frequent. Their diagnosis was strongly suspected by clinical examination of the patient, but was always confirmed by endoscopy which revealed their exact site in relation to the vocal cords or carina, essential information for the choice of incision when it is decided to perform surgery. Twenty-five patients were treated medically. Treatment was always combined with gastrointestinal resting, control of gastro-oesophageal reflux and broad-spectrum systemic antibiotics. There were 19 deaths and 6 fistulae closed spontaneously. Three of these 6 patients developed a secondary tracheal stenosis, 2 of which were treated surgically by resection-anastomosis. Ten fistulae were closed surgically with a good long-term result. The indication for surgery was essentially based on the patients general and infectious status and on his or her respiratory autonomy. Technically, we always combined direct suture of the two organs with interposition of muscular or pleural tissue.

Adult↗
PubMed2000

Running suturing: the ideal length facilitates this task.

BACKGROUND AND PURPOSE: Laparoscopic intracorporeal suturing is difficult, a complex task involving several integrated skills such as needle handling, suturing, and knotting. Running suturing is even more complex in the closed environment secondary to the angles of the suture lines, the tension maintained on the suture line, and the need to secure the ends, including tying a knot from the tail of the suture to the loop of the preceding stitch. We have hypothesized that the ideal suture length facilitates this process, and this study was specifically designed to determine the ideal suture length for an intracorporeal running suture. MATERIALS AND METHODS: Latex phantoms were incised for 1 or 2 cm, and each was marked with black points to indicate suture entrance and exit sites. These marks were placed 2 mm from the incision, starting 2 mm proximally and ending 2 mm distally. Suture lengths could then be varied in direct proportion to the length of the incision, keeping all of these points as constants. The ratios of suture length:incision length were 9:1, 10:1, and 11:1. One surgeon performed all of the running suturing utilizing dry 3-0 coated polyglactin with a tapered SH needle. The times needed to create running suture lines were recorded (seconds), the number of ideal entrance and exit points tabulated, and the number of technical errors (missed movements resulting in prolonged suturing) recorded. RESULTS: The lengths of both the incision and the suture affect the ability to perform laparoscopic intracorporeal running suturing. As the incision increased, the suture:incision ratio of 9:1 resulted in the most efficient results (quickest suturing and fewest errors). In smaller suture lines (1 cm), the ratios 10:1 and 11:1 appeared better. CONCLUSIONS: A suture:incision ratio of 9:1 is best for longer suture lines and 10:1 is better for short suture lines.

Evaluation Studies as Topic↗
PubMed1990

Osteoplasty of the mandibular condyle with preservation of the articular soft tissue cover: comparison of fibrin sealant and sutures for fixation of the articular soft tissue cover in rabbits.

Fibrin sealant and sutures were compared for fixation of the articular soft tissue cover after it had been raised in association with osteoplasty of the mandibular condyle. Nine adult rabbits were operated on bilaterally with the use of fibrin sealant on one joint and sutures on the other joint. The rabbits were killed after 3 months. Macroscopic and histologic evaluations of the condyles did not reveal any appreciable differences between the two techniques. Fibrin sealant was, however, technically easier to apply than the sutures. It was concluded that fibrin sealant might be an alternative to sutures for fixation of the articular soft tissue cover after it has been raised in association with osteoplasty of the mandibular condyle.

Animals↗
PubMed1975

Homologous dura mater cardiac valves. Structural aspects of eight implanted valves.

We studied eight homologous dura mater valves removed 1 to 35 months after implantation. Five dura mater valves were placed in the mitral position and three in the aortic position. Two of the valves were obtained after deaths not related to the valve itself and six after reoperations due to immediate or late incompetence. In 2 cases the dura mater valves were entirely normal, both macroscopically and microscopically. In 2 other cases the leaflets were caught by stitches related to the struts, a technical error that caused laceration of the leaflets. Not withstanding this fact, the dura mater was normal on histologic examination. In 3 cases, and probably in 1 other, one or two leaflets were detached partially from the suture line, probably because of a technical error in the manufacture of the valve. These studies demonstrated satisfactory evolution of the homologous dura mater valves until 35 months after implantation. No signs of rejection or degeneration of the dura mater were observed in the present series.

Adolescent↗
PubMed1983

[Surgical treatment of patent ductus arteriosus in adults].

The surgical treatment of patent ductus arteriosus (PDA) in adults as in children, usually comprises section and suture, but a certain number of technical precautions must be taken. The aortic wall is often fragile due to atheromatous lesions which are more common with increasing age. Associated hypertension may add to the fragility. Controlled medicated hypotension and reinforcement of sutures with a piece of pericardium may be useful in reducing the risk of haemorrhage. It is sometimes necessary to use partial femoro-femoral cardiopulmonary bypass circuit. The presence of an aneurysm at the aortic end of a calcified ductus necessitates the same precautions. When PDA is complicated by pulmonary hypertension, the surgical indication can only be considered when the left-to-right shunt remains voluminous and when pulmonary artery pressures fall significantly during catheter or peroperative trials of closure. The operative risk in these cases increases with age. Cardiopulmonary bypass may also be very useful in these cases. Secondary repermeabilisation of an operated ductus, and cases complicated by endocarditis require an endopulmonary approach under cardiopulmonary bypass because of the fragility of the ductus region and difficulty in controlling haemorrhage. This technique is also preferred when an associated intracardiac malformation is to be corrected. Between 1965 and 1981, 37 patients were operated in the department of thoracic and cardiac surgery at the Pitié Hospital. The ages ranged from 20 to 65 years with a mean of 34 years. Cardiopulmonary bypass was necessary in 5 cases, (partial in 4, and total in 1 case of endoaortic closure).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

New technique for purse string suture in stapled esophagojejunostomy using a new "needle cap" device.

Stapler anastomosis has been widely used in esophagojejunostomy following total gastrectomy. Purse string suture around the cut esophagus must be placed before stapler anastomosis. However, technical problems associated with placement of the purse string suture remain. We have designed a new reusable "needle cap" device, allowing purse string suture to be performed easily, safely, and cost-effectively. We present herein a new technique for purse string suture in stapled esophagojejunostomy using this device.

Equipment Design↗
PubMed1984

[Nerve anastomoses. Sutures or fibrinogenic glue? Preliminary results].

A comparative animal experiment was set up between two nerve anastomosis techniques, one by sealing nerve ends with a fibrinogen-thrombine glue and the other by classical perineural suturing. It was concluded that glueing nerve ends, from the surgical-technical point of view is a better method than suturing. It is an easy, time-sparing method which allows excellent coaptation of the severed nerves with minimal iatrogenic trauma. On the long run however some questions remain. There is the problem of induced fibrosis by using high doses of aprotinine and factor XIII at the site of the nerve junctions and on the other hand the influence of fibrinolysis in traumatized tissues, with early decrease of tensile strength at the junctions before nerve healing. So glued nerve ends should be completely free of tension, protected against secondary shearing forces, and also immobilization of the region is required.

Animals↗
PubMed2002

[Use of the B-Lynch suture technique in postpartum hemorrhage].

BACKGROUND: Serious postpartum haemorrhage occurs in approximately 1.4% of all deliveries in Norway and may result in hysterectomy. Stepwise devascularisation and hysterectomy are technically difficult and time consuming. A simple suture technique, B-Lynch suture, has recently been introduced, by which atonic postpartum haemorrhage may be controlled and hysterectomy avoided. MATERIAL, METHODS AND RESULTS: We have used the B-Lynch technique in five patients with serious postpartum uterine atonia and haemorrhage. In all patients serious bleeding and hysterectomy were avoided. Three of the patients are described in detail, one with failed induction of labour resulting in Caesarean section, one with placenta previa, and one with prolonged normal vaginal delivery. INTERPRETATION: If performed early, the B-Lynch suture technique is less mutilating to the woman; it may prevent excessive blood loss and is probably beneficial for the patient's future fertility. It is easy to perform in Caesarean sections and can be adopted in vaginal deliveries.

Adult↗
PubMed1995

A simple assessment of surgical sutures and knots.

The Surgeons' knot is both technically complex and difficult for junior surgeons to tie, especially when using heavy monofilament material. Knot slippage or breakage can pass unrecognized as a cause of wound dehisence, and it has been suggested that the Aberdeen knot and the Half-blood knot are easier and safer than the Surgeons' knot for tying these materials. The effect of different knots upon the breaking strain of common monofilament sutures was assessed using an Instron Tensiometer. The Surgeons' knot significantly reduced the breaking strength of all materials (P < 0.001). Using the Half-blood knot to commence closure had no significant effect upon strength. The Surgeons' knot, tied using the penultimate loop as at termination of closure, was associated with a significant risk of slippage, most noticeably with looped nylon. The Aberdeen knot, used for closure, showed no such slippage, and did not significantly weaken the suture (P < 0.05), except for polydiaxanone. In view of the ease of tying, security of knot and non-weakening properties, we recommend starting midline closure with a Half-blood knot and terminating with an Aberdeen knot.

Humans↗
PubMed2005

Laparoscopic extravesical ureteral reimplantation in adults using intracorporeal freehand suturing: report of two cases.

BACKGROUND AND PURPOSE: Laparoscopic extravesical neoureterocystostomy is an infrequently described technique in adults. It is a technically demanding procedure, especially when the intracorporeal freehand suturing technique is used. Our aim is to describe two cases where we used the intracorporeal freehand suturing technique successfully for performing laparoscopic extravesical transperitoneal ureteral reimplantation. We describe the preliminary results of these cases. PATIENTS AND METHODS: We performed this surgery in two female patients. The first patient had a low ureterovaginal fistula after abdominal hysterectomy. We performed a laparoscopic extravesical neoureterocystostomy by the refluxing technique. The second patient had a lower-third ureteral stricture. We performed a laparoscopic extravesical neoureterocystostomy with detrusorrhaphy and supported it with a psoas hitch. RESULTS: The average surgical time was 235 minutes. The average blood loss was 50 mL. The average stay was 48 hours, and the average time to starting oral intake was 12 hours. The average requirement for postoperative analgesia was one injection of diclofenac sodium, followed by oral ibuprofen. Follow-up urography showed good clearance of the kidney and ureter. The second patient, in whom the detrusorrhaphy was performed, did not show any reflux on the postoperative cystogram. CONCLUSION: Laparoscopic extravesical neoureterocystostomy using intracorporeal freehand suturing technique, combining detrusorrhaphy and psoas hitch, is a feasible procedure in adults for various indications. The detrusorrhaphy was effective in preventing reflux, but the long-term results need to be evaluated.

Adult↗