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At least 1,279 records · Page 71Linked to original sources
PubMed2003

A light-activated surgical adhesive technique for sutureless ophthalmic surgery.

OBJECTIVE: To investigate a scaffold-enhanced, light-activated bioadhesive technique as a substitute for sutures in ophthalmic surgery. CLINICAL RELEVANCE: Suture use in ophthalmic surgery is technically demanding and time consuming and may be associated with serious complications such as inadvertent ocular penetration, which can result in retinal detachment and endophthalmitis. Bioadhesive surgery could eliminate many complications and limitations associated with the use of sutures. METHODS: The bioadhesive was composed of a poly(L-lactic-co-glycolic acid) (PLGA) porous scaffold doped with a protein solder mix composed of serum albumin and indocyanine green, which was activated with a diode laser. Extraocular rectus muscle-to-extraocular rectus muscle, sclera-to-sclera, and extraocular rectus muscle-to-sclera adhesions were created in freshly harvested tissue followed by tensile-strength testing of these surgical adhesions. RESULTS: Optimum tensile strength for muscle-to-muscle repair was achieved with 50% wt/vol bovine serum albumin and 0.5 mg/mL of indocyanine green saturated into a PLGA porous scaffold and activated with an 808-nm diode laser. The tensile strength was 81% of the native muscle's tensile strength (mean +/- SD, 433 +/- 70 g vs 494 +/- 73 g). Sclera-to-sclera adhesions achieved a mean +/- SD tensile strength of 295 +/- 38 g, whereas that for extraocular rectus muscle-to-sclera adhesions was 309 +/- 37 g. CONCLUSION: Sutureless surgery using this bioadhesive technique for various ophthalmic procedures appears feasible and may result in reduced surgical complications and cost.

Animals↗
PubMedDate not supplied

Circumferential suture of the mitral annulus for correction of mitral regurgitation in dogs.

OBJECTIVE: To develop a method for reducing mitral regurgitation in dogs by positioning and tightening a circumferential suture around the mitral valve annulus. STUDY DESIGN: Description of clinical cases. ANIMALS: 15 dogs with spontaneous mitral valve disease, annular dilation, and refractory congestive heart failure treated between 1962 and 1994. METHODS: A composite suture material was constructed using braided Teflon-impregnated polyester sternotomy suture, barium sulfate thread, and Silastic tubing. Through a left lateral thoracotomy, the suture was positioned around the mitral annulus by passing it through the coronary sinus, right atrium, and underneath the left coronary arteries before tightening it. RESULTS: Six dogs died during surgery because of hemorrhage from the left atrium, coronary sinus, or left coronary artery. Three dogs died postoperatively because of coronary artery compression by the suture. Satisfactory suture placement was achieved in six dogs, three of which were long-term survivors (6 to 26 months) before they were euthanatized for noncardiac reasons. CONCLUSIONS: Reduction of mitral annulus diameter with a circumferential purse-string suture does not require cardiopulmonary bypass. The surgery is technically difficult, and detailed knowledge of coronary artery anatomy is required. The current suture design is inexpensive, radiopaque, and biocompatible; no special instruments are required for placement. CLINICAL RELEVANCE: Mitral regurgitation is the most common cardiovascular disorder in dogs and the most common cause of congestive heart failure. Annular dilation occurs as a consequence of mitral regurgitation. Placement and tightening of a circumferential suture around the mitral annulus reduces the degree of mitral regurgitation.

Animals↗
PubMed2006

Staplerless laparoscopic gastric bypass: a new option in bariatric surgery.

The staplerless Roux-en-Y gastric bypass (RYGBP) is a new option in bariatric surgery. The first to describe it was Himpens (2004) utilizing the LigaSure Atlas (LSA) in a series of 10 patients. The laparoscopic RYGBP is performed utilizing the LSA for the gastric and jejunal partition; after that, an imbricating running suture is performed to ensure stomach and bowel hermetic closure. All anastomoses are hand-sewn. Technical disadvantages are: learning curve; complications related to suture failure; possible thermal/electricity related injuries; longer operating time. Advantages are: stapler-associated bleeding, leaks, staple-line disruption, and fistulas are avoided; cost reduction. The staplerless RYGBP is complex; the surgeon involved requires expertise and ability. This technique will evolve and will be used by more surgeons. It is a new option for the surgeon preoccupied with costs, which is particularly important in developing countries.

Anastomosis, Roux-en-Y↗
PubMed2002

Role of routine intraoperative endoscopy in laparoscopic bariatric surgery.

BACKGROUND: Laparoscopic bariatric surgery is a challenging procedure with a high risk of technical misadventures that may increase postoperative morbidity. Routine intraoperative endoscopy may reduce postoperative morbidity. This article reviews our 6-year experience. METHODS: From April 1995 to September 2001, we performed 825 laparoscopic bariatric procedures: 743 roux gastric bypasses, 55 vertical banded gastroplasties, 18 laparoscopic adjustable gastric bands, and 9 gastric pacemakers. All the patients underwent flexible endoscopy by the primary surgeon at completion of the operation to assess for technical errors. RESULTS: The 34 intraoperative technical errors (4.1%) identified included 29 suture and staple line leaks, 2 bougie perforations, 2 inadvertent stoma closures secondary to the suture line, and 1 mucosal perforation in a gastric pacemaker. All the errors were successfully repaired laparoscopically at the time of the procedure. Three leaks occurred postoperative (0.36%): 1 in the 34 repaired errors (2.9%) and 2 in the remaining 791 patients (0.25%). CONCLUSIONS: Routine intraoperative endoscopy identified 34 correctable technical errors in a series of 825 laparoscopic bariatric procedures. Of these, 33 (97%) were repaired successfully, which reduced postoperative morbidity.

Adolescent↗
PubMed1981

[Value of circular mechanical colon and rectum anastomosis. Prospective study of 91 patients].

A prospective study was carried out on 91 patients to evaluate colonic and rectal anastomoses constructed with an EEA stapling gun. The concept comprises the following: orthograde lavage, cecal fistula or colostomy, intraoperative sufficiency control of the anastomosis, intraoperative direct measurement of the height of the anastomosis, postoperative X-ray control of the anastomosis using standardized techniques, classification of the cases into three groups according to the height of the anastomosis: 3-5 cm, and over 9 cm. Characterization of the patients was accomplished biostatistically using the Median-Quartil system. Primary hospital letality of 2% was due to heart failure. Imparied wound healing occurred in 11%. Secondary suture dehiscence was roentgenologically identified in a total of 18% of which only 7% showed clinical symptoms. Stenosis was determined by X-ray in 11% with only 1% demonstrating a temporary clinical correlation. For especially low rectal anastomoses at 3-5 cm the EEA stapling gun appears to have a great technical advantage over hand-placed sutures, allowing extension of indications for low anastomoses.

Adolescent↗
PubMed2006

Tensiometry as a measure of improvement in knot quality in undergraduate medical students.

INTRODUCTION: This study examined the validity of tensiometry as an objective method of assessing the improvements in the quality of knots and technical performance due to practice on suturing and knot-tying skills. METHODS: We evaluated the quality of 1,830 knots produced by undergraduate medical students before training (pre-test), after (post-test), and after a week retention (retention-test) using tensiometry. These results were compared to expert-based assessments of products and performance. RESULTS: Tensiometry, as well as expert-based assessments can detect changes in the quality of knots and technical performance from pre to post and retention-test ( p<0.05). However, these three methods may assess different dimensions of the same products and actions. CONCLUSIONS: The development of trainee evaluation criteria for the acquisition of surgical skills is a crucial element in surgical education. Based on our patterns of results it is hypothesized that tensiometry can serve as an economic first approximation of the quality of knots and suturing performance.

Analysis of Variance↗
PubMed2005

Mesh fixation in laparoscopic repair of ventral hernia: a new method.

During laparoscopic repair of ventral hernia, optimal fixation of the prosthetic mesh to the abdominal wall includes transfascial fixation with sutures in addition to fixation with a stapling, clipping, or tacking device. With the current methods, intracorporeal passage grasping and retrieval of sutures from the abdominal cavity are technically difficult. The reason for this difficulty is the lack of three-dimensional visual feedback during conventional laparoscopy. An easier method is needed. A new method using T-shaped anchors (T-anchors) is described. A T-anchor is a horizontal bar made of rigid titanium that is attached to a vertical limb made of monofilament suture. T-anchors are deployed in pairs, through a needle, and are tied over a musculofascial bridge to achieve transfascial fixation of the mesh to the abdominal wall. This method eliminates the need for intracorporeal grasping and retrieval of the sutures.

Hernia, Ventral↗
PubMed1975

[Comprative evaluation of the immediate results of gastrectomy with different types of esophago-intestinal anastomosis].

Using the experience with 207 gastrectomies the author presents an analysis of a dependence of incompetency of enteroesophageal anastomosis sutures on the operative approach, extent of surgery, method of enteroesophagostomy, number of suture rows. The author's data evidence that incompetency of anastomosis sutures in gastrectomy is the principal cause of mortality in the postoperative period. The mortality due to suture incompetency while using a thoracoabdominal access is considerably higher than in transabdominal approach. The Sapozhnikov-Judin technic yields the least per cent of anastomotic suture incompetency (2%), whereas the Gilyarovich method--the highest (18.7%). The use of three-row sutures in formation of the anastomosis decreases twice the percent of suture incompetency. Extension of gastrectomy to a combined one does not increase the percentage of suture incompetency. Constant improvement of the Sapozhnikov-Judin method might permit to reduce to a minimum the anastomosis suture incompetency in gastrectomy.

Esophagus↗
PubMed2004

Bimodal assessment of laparoscopic suturing skills: construct and concurrent validity.

BACKGROUND: The assessment of technical skills should provide objective feedback and judge suitability of progress during training. The aim of this study was to validate two objective assessment techniques for laparoscopic suturing and demonstrate a correlation between them. METHODS: Six experts, seven surgeons skilled in laparoscopic suturing, and 13 with no laparoscopic suturing skills were asked to place two or three intracorporeal sutures on a synthetic suture pad. The latter group was given video-based instructions prior to the execution of the sutures. Ergonomic conditions were standardized for all subjects. The procedures were recorded on videotape and two blinded observers rated the first suture of each subject on a 29-point checklist. A motion analysis system, Imperial College Surgical Assessment Device, was used to assess psychomotor skills. RESULTS: There was a significant difference in the time taken (p = 0.000) and total path length (p = 0.000) per suture across the groups. There were also a significant difference in the total checklist score (p = 0.000) and its individual categories. The was a strong correlation between the total path length and the total checklist score (coefficient, 0.78; p < 0.001). CONCLUSIONS: A combination of the motion analysis system and the checklist would make the process of formative feedback during the learning of intracorporeal suturing objective and comprehensive.

Clinical Competence↗
PubMed1995

Arthroscopic Bankart repair with the Suretac device. Part II: Experimental observations.

Arthroscopic Bankart repair using the Suretac device (Acufex Microsurgical, Mansfield, MA) was developed as an alternative to both the staple and suture repair techniques. While offering some technical advantages compared with these other approaches, it's technical limitations and pitfalls have only been described anecdotally based on the clinical experience of several surgeons. The purpose of this study was to define these limitations and pitfalls. Eight cadaver shoulders underwent arthroscopic Bankart repair using the Suretac device after first arthroscopically creating a Bankart lesion. These shoulders were then dissected to reveal the placement of the Suretacs and the adequacy of the Bankart lesion repair. Glenoids were transected in the transverse plane and embedded in clear methylmethacrylate to show placement of the Suretac device relative to the articular surface. There were several technical errors that occurred: (1) Inadequate abrasion of the anterior and inferior juxta-articular scapular neck; (2) inadequate superior and medial shift of the inferior glenohumeral ligament before placement of the lowest Suretac, (3) medial placement of the Suretac relative to the articular margin; and (4) insufficient capture and compression of capsular tissue by the Suretac device. This procedure is technically difficult and careful attention must be paid to each step of preparation and repair. Recognition of the common errors may help the surgeon to avoid these pitfalls in the clinical situation.

Arthroscopy↗
PubMed1992

Bricker-Johnston sigmoid colon graft for repair of postradiation rectovaginal fistula and stricture performed with mechanical sutures.

In patients with postradiation rectovaginal fistula who are otherwise healthy and cured of their cancer, repair of the fistula with return to a normal lifestyle is indicated if this repair can be achieved with minimal morbidity, no mortality, and a good prospect for a functionally satisfactory result. The Bricker-Johnston vascular sigmoid colon graft fulfills these conditions by respecting the tissular equilibrium of the radiated rectum and supplying the area with a sound, vascular sigmoid pedicle graft. While this improves tissue vitality locally, it restores rectal function to a near-normal preradiation level and preserves the previously intact sphincter muscles. The concept of this repair is very sound, and its implementation is greatly facilitated technically by the use of mechanical suture instruments. In this presentation, we describe and show the use of stapling instruments in achieving a three-stage repair of a rectovaginal fistula with Bricker and Johnston's technique.

Anastomosis, Surgical↗
PubMed1989

Vacuum-stiffened beanbag for cranial remodeling procedures in modified prone position. Technical note.

In surgical correction of multiple-suture synostosis, placing the patient in the modified prone position permits access to the calvarium from the supraorbital ridge to the occipital bone below the transverse sinus. The modified prone position thereby enables surgeons to perform cranial remodeling procedures at one stage under direct vision, contributing to improved surgical results. However, no satisfactory head-frame for this position has been available. The authors report the successful use of a vinyl bag filled with styrofoam beads to achieve the modified prone position in young children. This widely available, economical device provides a safe, reliable means of positioning the child's head for cranial remodeling procedures.

Child, Preschool↗
PubMed1989

[A new technic for esophago-enteral anastomosis with a mechanical stapler without purse-string sutures].

Staplers have improved the results of esophageal surgery, in our experience and in others experience, as esophago-enteric anastomoses have become safer and faster than when manual suturing is used. Probably one of the last problems in the stapler technique, especially in the thoracic area, is the performance of on adequate esophageal purse-string suture: an improper performance of this suture can cause a dangerous leak of the anastomosis. So, many surgeons, to reduce the risk of esophageal dehiscence connected with the esophageal purse-string, use either purse-string devices or alternative methods such as a second handsewn purse-string, U stitches of the esophagus, etc. We think that the risk of improper anastomoses after esophageal resection can be reduced if the need for the esophageal purse-string can be eliminated. This work shows our personal technique for performing esophagoenterostomy, especially in the thoracic area, using the new CEEA stapler (Autosuture) without esophageal purse-string sutures. According to the modified procedure the stapler anvil and the mini rod are introduced in the esophagectomy and a 2-0 thread is knotted around the CEEA mini rod. Then the esophageal mutilated part is closed by a linear stapler keeping a syringe needle, which contains the thread, through the linear suture. Then, using the thread as a pulling system, the surgeon makes the needle and the tip of the mini rod slide out of the esophageal suture. Now the surgeon can reassemble the CEEA and perform the anastomosis. There are many clinical reports that cite no leaks following circular stapled anastomoses across linear stapled closures.

Anastomosis, Surgical↗
PubMed2001

[A technique of continuous sutures for reconstruction of episiotomies].

The aim of the study is to establish the possibility for reconstructing episiotomies with a continuous uninterrupted suture. In a prospective study are included 54 women with a lateral episiotomy without further lacerations. As sewing material were used Cat-gut or Vicryl Rapide. Reconstruction of vagina, perineum and skin is done by a continuous suture with a single thread. The technical accomplishment does not provide problems to the surgeon. What is more, it reduces the durability of the intervention by achieving a good haemostasis and anatomic adaptation. All episiotomies heal per priman. An important advantage for women from a psychoemotinal point of view is the lack of the necessity to remove threads.

Episiotomy↗
PubMed1985

[Colon-rectal anastomosis with mechanical sutures (personal experience in 96 cases)].

From 1 October 1981 to 30 September 1985 ninety-six patients underwent colorectal resection with EEA Auto-suture stapled anastomosis for cancer or diverticula. As compared with manual suture, the mechanical procedure involved some technical problems and peroperative drawbacks (partial leakage, hemorrhage), which decreased after the initial phase of our experience. The EEA Stapler proved a reliable and useful procedure, especially in low colo-rectal anastomoses, which present a higher risk of leakage, owing to difficulties with manual technique. Clinical or x-ray fistulas occurred in four patients after colon-to-colon (5.8%) and were six following colorectal anastomoses (22.2%). Only in three cases a colostomy was necessary. In spite of suitability of the mechanical procedure, a colostomy was carried out to protect low colo-rectal anastomoses, when general risk factors were present or when the suture was improperly performed or transection circles were incomplete. The introduction of the EEA Stapler allowed for a higher number of anterior resection of the rectum, with a corresponding decrease of abdominoperineal procedures, and promoted a more extensive indication to palliative anterior resection. It is still a matter of concern whether the high number of anterior resections would be followed by an increased local recurrence rate, in consideration that radicality depends on a wide exeresis with a complete lymphoadenectomy.

Aged↗
PubMedDate not supplied

Evolution of staples and clips for vascular anastomoses.

Because of the development of less invasive surgical techniques, there is an increasing demand for vascular anastomosing techniques that require less exposure of the operating field. This paper reviews the most important representatives of staples, clips, and other mechanical devices for vascular anastomosing described over the last five decades. This report is organized in three parts: (1) the history of clipping and stapling devices, (2) development of the Vessel Closure System (VCS) clips, and (3) current and potential status of mechanical vascular anastomotic devices. A Medline literature search was conducted and publications on the use of staples and/or clips for the creation of vascular anastomoses identified with extensive cross-referencing. The first literature description of a mechanical vascular stapling device was by Gudov in 1950. This and other reports from the Soviet Union stimulated brisk, competitive development of vascular anastomotic devices in Europe, North America, and Japan. Fasteners included staples, penetrating pin-rings, or toothed stainless steel clips, none of which gained acceptance because of their complexity and inability to facilitate end-to-side anastomoses. A more convenient and less traumatic anastomotic system (VCS Clip applier system) was introduced into clinical practice in 1995. This system differs from staples in that it is non-penetrating. A wide variety of reports have described the advantages, both technical and biological, that clips provide over conventional needle-and-suture, particularly for the construction of vascular access for hemodialysis. A steady evolution of mechanical vascular anastomotic devices has sought to eliminate the technical and biological disadvantages of conventional suturing. Although the conventional hand-sewn, overcast non-absorbable suture remains the "gold" standard, newer techniques such as the non-penetrating arcuate-legged VCS clips are gaining acceptance as a useful addition to the vascular surgeons' armamentarium.

Anastomosis, Surgical↗
PubMedDate not supplied

Repair of quadriceps tendon ruptures using suture anchors.

The repair of ruptured quadriceps tendon is commonly performed by weaving sutures through the ruptured tendon and then attaching the tendon to the bone by passing these sutures through tunnels in the superior patella. This technical note is the first report we are aware of in the English language literature of a technique that uses suture anchors to attach the tendon to bone.

Basketball↗