Evaluation of endoscopic ligation treatment of colonic polyps.
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Colonic Neoplasms↗
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Simplified anterior resection: Use of the ta stapler.
Forty consecutive anterior resections using TA stapler were studied. No mortality, no clinical leak, and no infection were encountered in this group. The stapler is recommended as an aid in simplifying the operation and lessening the operative time.
Adult↗
[The treatment of post-traumatic recurrent anterior shoulder dislocation using Du Toit's operation].
From 1.4. 1986 to 31.12. 1987 we operated 21 patients with a recurrent anterior dislocation of the shoulder with the Du Toit staple capsulorrhaphy. 20 patients we followed clinically and radiologically for an average period of one year and four months. By using a rating sheet 17 patients had an excellent and three patients a good result. There was, against other operation techniques, a minimally limiting of external rotation. We had no recurrents of dislocation. We concluded that the Du Toit staple capsulorrhaphy makes necessary only short postoperative immobilisation and renders an early return of motion and that a good function can be expected.
Adult↗
A "modified Whitehead" hemorrhoidectomy.
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Adolescent↗
Intraoperative Chaffin sump recto-colonic irrigation.
A simple method for intraoperative rectocolonic irrigation using the time-honored Chaffin sump drain is recommended. It assures an empty particulate matter-free bowel for anastomosis, washes out malignant cells, and provides proof of the integrity of anastomosis and decompression of the proximal bowel when indicated.
Colon↗
Medical history: Seishu Hanaoka and his success in breast cancer surgery under general anesthesia two hundred years ago.
In 1804, Seishu Hanaoka performed the first successful surgical treatment of breast cancer under general anesthesia in the world. It preceded by 38 years C W Long's trial of ether anesthesia in 1842. In this paper, Hanaoka's biography and his contributions to surgery and anesthesiology in those days, and also his advanced ideas about medicine and sanitation are presented. Hanaoka had made many efforts to develop the optimal prescription of the anesthetic " Tsusensan(or Mafutsu-To)" for almost 20 years. Finally, he succeeded in using it clinically for breast cancer surgery, on October 13, 1804. Hanaoka performed operations for breast cancer in a total of 156 cases, and also for many other kinds of surgical procedures. He also eagerly contrived and modified many surgical instruments. In spite of such a busy daily schedule, he eagerly trained and educated many students, using his own philosophy for medical management. Details of his background and some discussion from a present-day viewpoints are included.
Anesthesia, General↗
[Free intraperitoneal clip as the cause of mechanical ileus of the small intestine].
In the last 10 years the use of mechanical stapling devices in endoscopic surgery have found wide-spread application and acceptance. Even one of the most common surgical operations, the appendectomy, is done regularly laparoscopically. Therefore, utilization of endostaples is commonplace and often results in the spillage of fired staples beyond the margin tissue. We report the case of a 23-year-old patient who developed the clinical signs of bowel obstruction 2 weeks after laparoscopical appendectomy. An exploratory laparotomy was subsequently performed. At the time of exploration, a single band was identified that draped over the ilium central affixed to a staple. The staple was removed and the obstruction relieved without bowel resection. The patient had an uncomplicated recovery. We believe that the cause of this mechanical bowel obstruction was a loose staple.
Adult↗
[The VCS clip--experimental experiences with a new vascular suture stapling device].
Despite improvements in technique and suture material, vascular anastomosis is still associated with a significant rate of early (stenosis, thrombosis) and late (intimal hyperplasia) complications. Although automatic mechanical staplers were practical und comparatively safe to use, they did not play a major role in vascular surgery, probably due to the complexity and difficult handling. In an experimental study with the VCS clip system, we found a significant improvement in performing a hepatic artery anastomosis [9.2 +/- 1.5 min (VCS) vs 20.6 +/- 2.7 min (suture), P < 0.001], early patency and flow rate [150 +/- 29.1 ml/min (1.0 h)-->79.9 +/- 24.0 ml/min (24 h) (suture) vs 186 +/- 45 ml/min (1.0 h)-->162 +/- 48 ml/min (VCS), P < 0.005]. Besides easy handling, the VCS clip system allows for a fast, standardized vascular anastomosis without intimal penetration.
Anastomosis, Surgical↗
Stapled mucosal prolapsectomy for haemorrhoidal prolapse with Lone Star Retractor System.
This technical note presents a variation of the stapled mucosal prolapsectomy for haemorrhoidal prolapse using the Lone Star Retractor. Our experience highlights the simplicity and usefulness of the technique which is based on the complete eversion of the prolapse carried out by the Lone Star Retractor, without using any kind of proctoscope and without stretching the anal sphincters. Postoperatively, rectal bleeding occurred in 4.7% of 127 cases, 9.8% of the patients complained of faecal urgency and only 3.9% had severe anal pain. None had faecal incontinence. This method simplifies the making of the purse-string suture as well as the use of the suturing device and achieves satisfactory clinical results.
Adult↗
[Reliable and unreliable health measures in surgery].
Despite high standards in theatre design, surgical skills and antibiotic prophylaxis, surgical site infections are still a major complication in modern surgery. After urinary tract infections and lower respiratory tract infections they account for 15.8% of all nosocomial infections in Germany [31]. Causes are multiple and only partially exogenous. The single most important (exogenous) risk factor is the technical skill of the surgeon. Not all surgical site infections are therefore preventable by infection control measures alone. Useful and useless infection control measures will be evaluated critically in the following review according to data in the literature.
Air Microbiology↗
[Retained foreign bodies from the surgical point of view].
The number of foreign bodies remaining in the patient after a surgical procedure is presumably higher than mentioned in the literature. According to US insurance statistics, the incidence amounts to 1 in 1,500 surgical procedures. As a basic principle--also from the legal aspect--it is necessary to determine whether a foreign body was left in situ accidentally (i.e. due to a material fault) or if it was simply forgotten. In 70% of cases, fabric items (e.g. swabs etc.) are left behind, while around 30% are metal objects. A particularly high risk is seen in emergency settings, in unexpected changes in the surgical procedure, or for patients with a high body mass index. The outcome for the patient differs depending on the nature of the object left behind and the individual patient's situation. Usually, metal items cause more acute clinical symptoms at an earlier time after the operation. Fabric items tend to induce, in the absence of primary contamination, a chronic progression of symptoms over several years. Reoperation has a high mortality (between 11% and 35%). Precautions in terms of risk management have to be established and need to be strictly respected, especially in high risk settings. Visually or acoustically controlled monitoring before wound-closure are recommended to eliminate "human error" as thoroughly as possible.
Cross-Sectional Studies↗
[Complete pre-peritoneal endoscopic closure of inguinal hernias].
BACKGROUND: Considering the high recurrence rate after conventional inguinal hernia repair, the totally preperitoneal endoscopic inguinal hernia repair has been used. METHODS: The present experience of the authors embraces 1085 patients with a total of 1717 inguinal hernias, including 200 recurrences. The operative technique is described with emphasis on pitfalls and tricks. RESULTS: Analysis of the data concerning the first 403 patients with 1 year complete follow-up reveals a mean (SEM) operating time of 42 (1.2) min for unilateral and 58 (1.0) min for bilateral hernia repair. Mean (SEM) postoperative hospital stay was 2 (0.04) days. Complication rates during and after operation were 0.3% and 3.3% respectively. The morbidity rate at 1 month after operation was 3.5%. The recurrence rate was 0.3% at 1-year follow-up. CONCLUSION: Totally preperitoneal endoscopic inguinal hernia repair is safe and reproducible for any type of primary or recurrent inguinal hernia, even in patients with previous subumbilical surgery or severe systemic disease. Careful follow-up is mandatory to assess the late recurrence rate.
Adult↗
[The "short esophagus problem" in laparoscopic anti-reflux surgery].
INTRODUCTION: Esophageal shortening as a complication of advanced gastroesophageal reflux disease is seen in 2-4% of patients with GERD. For such patients undergoing laparoscopic antireflux surgery, the procedure is doomed to failure because of excessive tension. As a consequence, recurrent hiatal hernia or thoracic placement of the fundoplication with unfavorable functional results can occur. METHODS: The Collis gastroplasty as an esophageal lengthening procedure was first described by Collis in 1957. Collis gastroplasty combined with Nissen fundoplication produces an intraabdominal neoesophagus with a fundic wrap. RESULTS: We performed 255 laparoscopic antireflux procedures between March 1994 and February 2000. We report on five patients (2.0%) with a shortened esophagus treated with Collis gastroplasty and Nissen fundoplication. On follow-up, all patients showed symptomatic relief from reflux symptoms, especially from dysphagia. CONCLUSION: The Collis gastroplasty combined with Nissen fundoplication is an effective procedure in patients with shortened esophagus diagnosed intraoperatively during laparoscopic antireflux surgery. Because of neoesophageal acid production proximal to an intact fundoplication coupled with poor esophageal clearance, there was no complete restitution.
Adult↗
[Use of open MRI in head-neck surgery].
The vertical open MRI (Signa SP, 0, 5 Tesla) is ideal for interventional diagnosis and therapy. From our point of view indications in Otorhinolaryngology are biopsies of tumours which are difficult to access such as the petrous apex and the petroclival region, the parapharyngeal space and neck and the orbit. Furthermore the open MRI is useful in the surgery of paranasal sinuses, in the evaluation of tissue-resection and helpful in detection of the anatomy of delicate structures as the internal carotid artery, the skull-base and the orbit. Also navigation in open MRI is possible for example with a flash-point-system. The advantage to conventional navigation systems is the possibility of real-time-imaging, which allows detection of tissue shift occurring during the procedure. We report about our experience with ten biopsies of the petrous apex and the petroclival junction and two biopsy of the parapharyngeal space and the neck. Further experience was gained with MR guided placement of afterloading tubes into large neck metastases in three cases and microscopic surgery of paranasal sinuses in five cases. In all operative procedures an excellent resolution was found especially for soft tissue structures as for example blood vessels. With the aid of special pointer systems or artefacts by surgical instruments all relevant anatomical structures could be detected intraoperatively, concerning normal and pathologic tissue. Thus open MRI proved to be a helpful instrument in these operative procedures.
Adult↗
[A new parallel drill guide for navigating femoral neck screw placement. Development and evaluation].
BACKGROUND: Trauma navigation applications employ conventional mechanical surgical instruments for the simulation of drilling trajectories. Few complex mechanical targeting instruments, such as guides with fixed angles or with multiple parallel cannulas, have been adapted into trauma navigation systems. We have integrated a complex mechanical tool, the parallel drill guide (PDG) for the minimally invasive treatment of femoral neck fractures, into a trauma navigation module. The combined advantage of a complex yet commonly used mechanical tool with the benefits of fluoroscopic navigation was evaluated. MATERIAL AND METHODS: To adapt the conventional PDG to a fluoroscopic navigation system, the instrument was fitted with a non-detachable reflective marker array. Navigation engineers developed custom software to enable visualization of the navigated PDG. A comparison of conventional versus navigated PDG techniques was performed on plastic bone models and cadavers. No software or mechanical failures occurred with the navigated PDG procedures. RESULTS: While the total operative time was 30% more with navigation compared with conventional techniques, the total radiation time for the navigated group was reduced by more than 60%. This study demonstrates the successful integration of a cannulated parallel drill guide with a fluoroscopic navigation system. CONCLUSION: The continuous display of the complex PDG mechanical instrument, with multiple parallel virtual trajectories, enables safe and accurate parallel screw placement. The integration of complex mechanical instrumentation with navigation for the accurate placement of hardware represents an attractive direction in multiple trauma applications.
Bone Screws↗
[Paraplegia in cases of septic diseases of the spine].
BACKGROUND: Paraplegia of non-traumatic origin has an increasing incidence. Infection of the spine is a major contributor to the number of these cases. Besides adequate management of spinal cord injury, the treatment of these patients requires specific therapeutic techniques. PATIENTS AND METHODS: Eighteen patients with acute pyogenic infection of the spine and spinal cord injury were admitted to our facility in the years 1997-2000. All except two patients were treated by surgical debridement and internal stabilisation. RESULTS: The infections healed after surgical treatment in all cases. Neurological function improved and no patient showed neurological deterioration. Both patients who were not fit for surgery died during treatment. CONCLUSION: Surgical instrumentation and replacement of the destroyed vertebra, despite a pyogenic environment, resulted in permanent resolution of the infection. There is potential for neurological recovery but full recovery is rare.
Adult↗
Atraumatic tendon handling during tendon repair.
Two techniques are presented for atraumatic handling of tendon ends during repair of flexor and extensor tendons. If the tendon is cleanly transected, the suture is carried out by holding the tendon in nerve holding forceps. If debridement is needed, a slice is partly cut and used to handle the tendon; the slice is then cut off and discarded.
Humans↗
Lateral crus sculpturing in open rhinoplasty: the Delicate Alar Clamp.
The wide exposition obtained with the open approach in rhinoplasty allows a precise evaluation of size, morphology, thickness, and position of the alar cartilages. This precise intraoperative diagnosis has permitted the development and improvement of surgical techniques in nasal tip sculpturing. At the same time, many surgical instruments have been adapted or created for the external approach. We describe our preferred and most commonly selected sequence in primary rhinoplasty with emphasis on the nasal tip work. A new, personally developed instrument, named the Delicate Alar Clamp, utilized to hold and stabilize the lateral crus during measurement and sculpturing of the cartilage, is presented with the description of its technical characteristics and practical application.
Humans↗