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PubMed1987

[Uretero-ileal anastomosis using the modified Leduc-Camey technic. Surgical technic].

A modified Leduc-Camey technic for uretero-ileal anastomosis was used in 96 patients over a period of one year, complications related to this type of anastomosis, and requiring recovery surgery, being noted in 2 cases. When compared with more than 300 anastomoses performed using the original Leduc-Camey technic, this modified procedure using absorbable sutures appeared to be simple, effective and very rapid. It is a valid method for Camey type reconstruction bladders and also for Bricker type or Kock's pouch type continent diversion operations.

Adult↗
PubMed1990

Closure of blepharoplasty incisions with autologous fibrin glue.

Autologous fibrin glue was prepared from individual patients and used as a surgical adhesive. Sixteen patients undergoing elective eyelid operations were studied. The fibrinogen was prepared from autologous blood by a cryoprecipitate technique. When mixed with commercially available thrombin, a fibrin clot develops with sufficient adhesive strength that the need for extensive suturing is obviated. Complications were few, and due to technical factors in the initial cases, all patients were followed up for at least 1 year. Problems associated with suture closure of wounds (eg, cysts, granulomas, milia) were not seen. The fibrin glue not only sealed the wound but also acted as a hemostatic agent. The autologous preparation is superior to commercial products since it avoids the problem of transfusion-transmitted disease. The fibrin glue and minimal suture technique is an alternative to eyelid incision closure and may be useful in many other types of operative procedures.

Aged↗
PubMed1990

Stapled transabdominal lower esophageal anastomosis without purse-string suture.

Because of anatomic limitations at the EG junction in total and subtotal gastric resections, gastrointestinal reconstruction is technically challenging. In stapled anastomosis, suboptimal application of a purse-string suture to the distal esophagus may lead to anastomotic breakdown. We describe herein a technique in which this step is eliminated to achieve a sound, full thickness anastomosis with the use of the Roticulator TA 30 and the EEA Premium stapling instruments.

Anastomosis, Surgical↗
PubMed1987

Patency of laser-assisted anastomoses in small vessels: one-year follow-up.

Laser-assisted arterial anastomoses can now be performed with satisfactory short-term patency. This study was undertaken to evaluate patency and aneurysm formation with a 1-year follow-up. A microscopically guided CO2 laser was used to anastomose 1.5 to 2.0 mm carotid arteries in 24 rabbits. Under X6 to X40 magnification, 60 to 70 mW were delivered with a spot size of approximately 0.32 mm. One carotid artery underwent laser anastomosis; the opposite served as a sutured control (10-0 nylon sutures). The 48 end-to-end anastomoses were evaluated for patency and aneurysm formation at 3, 6, and 12 months. Aneurysms were defined as a 1.5 times increase in diameter at the anastomotic site. The vessels underwent microscopic examination. All laser-assisted and sutured anastomoses were patent up to 1 year. At 3 months, one of eight sutured and one of eight laser anastomoses were aneurysmal; stenosis was noted in one laser anastomosis. At 6 months, one of eight laser and 0 of eight sutured anastomoses were aneurysmal. At 12 months, one of eight rabbits had died; of the remaining seven, three of seven laser and zero of seven sutured anastomoses were aneurysmal. In total, five of 23 (21.7%) aneurysms developed with the laser technique and one of 23 (4.3%) with the suture technique (p less than 0.05). Laser-assisted anastomoses are technically feasible, and patency at 1 year is equal to those performed with the suture technique. Aneurysm formation is a consistent problem that demands further investigation.

Aneurysm↗
PubMed1984

Linton patch angioplasty. An adjunct to distal bypass with polytetrafluoroethylene grafts.

Expanded polytetrafluoroethylene (PTFE) grafts have shown promise in bypasses to the popliteal and tibial arteries, but a significant incidence of immediate and late graft failure has limited general acceptance. Compliance differences between the PTFE graft and artery may present technical difficulties in small vessel anastomosis, as well as being implicated in late development of intimal hyperplasia. A retrospective study of 68 patients who had bypass to the distal popliteal and tibial arteries using PTFE grafts with adjunctive distal patch angioplasty was undertaken. Operation was done for limb salvage in 85%. Runoff was marginal in 69%. A venous patch was sutured to the distal artery and the PTFE graft was then sutured into an opening in the proximal portion of the patch. There was one early graft occlusion. Cumulative patency was 97% at 1 month, 92% at 3 months, 87% at 6 months, 74% at 12 months, and 65% at 24, 36, and 48 months. A distal autogenous vein patch permits precise suturing of the distal anastomosis and minimizes technical difficulties leading to early graft failure. Improvement of the compliance mismatch of the PTFE graft and artery may impede the unwelcome development of intimal hyperplasia at the distal anastomotic site. The adjunctive use of a distal patch has resulted in excellent immediate graft patency, despite a high incidence of poor run-off and limb salvage situations.

Adult↗
PubMed1985

Use of a ringed intraluminal graft in the operative management of abdominal aortic aneurysms.

The efficacy of a non-sutured technique of anastomosis has been assessed in 20 patients who had bifurcated grafts inserted for aneurysms of the infrarenal aorta. The grafts had rigid Dacron-covered metal rings incorporated at each end and the anastomoses were effected by securing these rings within the lumen of the vessel with a firmly tied Dacron tape. In order to allow access of the ring to the lumen of the aorta it was necessary to employ an intraluminal occlusion balloon catheter for proximal control. The patients included in the study formed a particularly high risk group. There were 12 emergency and 8 elective procedures. The mean duration of the operations was 134 +/- 34 min (+/- s.d.); the mean blood loss during surgery was 3498 +/- 2660 ml (+/- s.d.) and the mean length of inpatient stay after operation was 16 +/- 13 days (+/- s.d.). There were eight postoperative deaths and post-mortem examination, which was allowed in six cases, showed satisfactory appearances of the grafts and anastomoses. The surviving patients have remained free from complications for up to 18 months after operation. A non-sutured technique is possible for most aortic anastomoses but is of limited applicability for iliac and more distal anastomoses. With further technical refinements an intraluminal graft with a non-sutured aortic anastomosis may become a valuable alternative to the conventionally sutured prosthesis in the management of ruptured abdominal aneurysms.

Aged↗
PubMed1986

Stainless steel skin staples--a useful electrode system for long-term electrophysiological measurements in neurosurgery. Technical note.

Stainless steel staples commonly used for skin suture were tested for their suitability as electrodes for recording electrophysiological data. Investigations were performed in vivo and as well as in vitro, and showed the typical behaviour of electrodes made from a polarizable metal, i.e., an increase of electrode impedance with low frequencies. In spite of this fact most electrophysiological data can be recorded if the input impedance of the amplifier is in the common range of 100 MOhms. Advantage of these electrodes is their quick and easy application, their resistance to mechanical stress and the possibility of leaving them in place for a long time.

Brain↗
PubMed1988

[Autoplasty in nerve injuries in children].

A comparative assessment of results of autoplasty and the epineural suture in 32 cases was made on the basis of a well-known scores system. It was established that under similar or close conditions influencing the regeneration the results proved to be the same in both groups. It suggests that the epidural suture is the method of choice in those children where it is not associated with technical difficulties. Autoplasty is indicated in cases where putting the epidural suture is impossible or difficult.

Adolescent↗
PubMedDate not supplied

Dacryocystorhinostomy utilizing an anterior lacrimal sac flap to periosteum technique.

Dacryocystorhinostomy is used in the effective treatment of epiphora secondary to obstruction of the lacrimal drainage system. Common causes of obstruction include canalicular disruption, lacrimal sac fibrosis, and external and internal nasal trauma. Most techniques of dacryocystorhinostomy attempt to suture the lacrimal sac mucosa to the nasal mucosa. At best this is technically difficult, and the mucosa frequently tears. A technique is presented using an anteriorly based lacrimal sac pedicle flap sutured to the periosteum of the anterior lacrimal crest. The sutured flap is quite strong, and the procedure is technically simpler than others. A brief description of the causes of lacrimal obstruction is given. The Jones primary and secondary dye tests for lacrimal system patency are reviewed.

Humans↗
PubMed2001

An adjustable superior oblique tendon spacer with the use of nonabsorbable suture.

PURPOSE: Philip Knapp described a method, sometimes referred to as the "chicken suture,"of securing a loose nonabsorbable suture to the cut ends of the superior oblique tendon to facilitate future reversal. The purpose of this study is to describe a modification of Knapp's technique to achieve partial, reversible, and intraoperatively adjustable superior oblique weakening. METHODS: The superior oblique tendon was exposed, 2 polyester nonabsorbable sutures were placed 4 mm apart, and the tendon was cut. With the use of a slip knot, the cut ends of the tendon were separated by 2 to 8 mm. Tendon separation was adjusted intraoperatively according to the exaggerated traction test and, in some cases, fundus torsion. Medical records of all patients who underwent surgery with this technique were reviewed and the outcomes tabulated. RESULTS: Twelve patients (16 eyes) were treated for superior oblique overaction and 3 patients (3 eyes) for Brown syndrome. Follow-up was 2 to 46 months (mean, 17 months). Mean superior oblique overaction improved from +1.3 before surgery to +0.3 after surgery, mean A pattern improved from 20 PD to 2 PD, and fundus intorsion improved from +1.2 to +0.3. In Brown syndrome, the mean elevation in adduction improved from -3.8 to -1.0. One patient from each group developed an overcorrection. None of the patients developed recurrence. The patients with Brown syndrome continued to improve over a 1-year period. CONCLUSIONS: The superior oblique tendon suture spacer is effective, intraoperatively adjustable, and technically easier to perform than a silicone expander procedure. This technique should be considered as an alternative for patients requiring superior oblique weakening.

Adolescent↗
PubMed2001

Laparsocopic ureteroureterostomy for retrocaval ureter.

Two cases of retrocaval ureter are reported that were successfully treated by a laparoscopic approach. Case 1 was a 20-year-old woman who presented with symptoms of a right ureter stone. Case 2 was a 23-year-old woman who had suffered from recurrent right flank pain with gross hematuria. A transperitoneal approach was used for case 1, and a retroperitoneal approach was used in case 2. Both were successfully treated with laparoscopic ureteroureterostomy using an intracorporeal suture technique. Laparoscopic surgery should be the first choice for retrocaval ureter not only because of the minimal invasiveness but also because of the cosmetic advantage compared to conventional open surgery. Further technical and instrumental advances are essential for intracorporeal suturing.

Adult↗
PubMedDate not supplied

A comparison of ultrasonic suture welding and traditional knot tying.

The slippage of knots and the technical challenge of tying them securely are potential impediments to certain arthroscopic procedures. Ultrasonic energy delivered at 70 kHz can be used to weld No. 2 polypropylene suture. This method was compared with a traditional knot (surgeon's knot with four alternating half hitches) tied with an open technique to determine whether welding of sutures is comparable, in mechanical properties, to hand-tied knots. Both loops were fashioned around a 0.25-inch mandrel and then tested. The load to reach 3-mm elongation (point of likely biologic failure of a repair) was significantly greater for welded sutures than for knots. The elongation at ultimate failure was significantly less for welded sutures than for knots. The number of cycles to failure and the creep after initial displacement were similar for both welded and knotted suture loops. The ultimate load to failure was significantly greater for the knotted than for the welded suture. The welding of suture for the repair of musculoskeletal soft tissue presents an attractive alternative to traditional knot tying, particularly for arthroscopic applications.

Equipment Failure Analysis↗
PubMed2003

A porcine beating heart model for robotic coronary artery surgery.

BACKGROUND: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis. METHODS: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test. RESULTS: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P <.0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P =.0049). CONCLUSIONS: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

Animals↗
PubMed1975

[Dexon, applicability in the horse (author's transl)].

Dexon is a new, synthetic, absorbable suture material. Its applicability for suturing distally in the extremities of horses was tested in 65 cases. The indications included burried sutures as well as skin closure. It was concluded that the material can be used with advantage in cases traditionally sutured with catgut, vetafil or mersilene. It is technically a pleasant material and has further the advantage that it shall not be removed.

Animals↗
PubMed1989

[Conservative coloproctectomy: the advantages of a circular trans-suture staple anastomosis after linear stapling of the everted rectum. Preliminary results].

Technical alternatives in conservative proctocolectomy are presently investigated to improve the functional results of the operation. To avoid 2 difficult steps in the procedure, mucosectomy and transanal manual suturing, is of interest to retain the entire and canal and to reduce anal stretching duration. A new technique of stapled anastomosis is described: after full mobilization and eversion of the rectum, this latter is closed using a linear stapler and cut immediately above the anal canal; a 18 cm long J pouch is constructed and the anastomosis is stapled using the new premium EEA instrument*. Clinical experience begun in 1989 january, concerns 6 patients (2 U.C., 4 polyposis): at this time, 5 of these had their ileostomy closed, functional results being under evaluation. This method allows 1) to retain all the anal canal, 2) to avoid prolonged anal dilatation, 3) to perform a rapid and safe stapled anastomosis.

Adult↗
PubMed2006

[Technique, results and impact of induction chemotherapy in sleeve lobectomy for lung cancer].

AIM: The aim of this study was to evaluate the safety of continuous nonabsorbable (3/0 polypropylene) sutures for sleeve lobectomy, and the influence of induction chemotherapy on postoperative outcome in patients with lung malignancies. METHODS: A review of a prospective database of a single surgeon identified 41 consecutive patients who underwent sleeve lobectomy from May 1998 to July 2003. Bronchial reconstruction was done placing two 3/0 polypropylene sutures at the far side of the cartilaginous wall and subsequently fixed. Afterwards, two running sutures were performed in order to obtain a telescopic anastomosis. RESULTS: Twenty-four patients (59%) underwent induction chemotherapy. There were 31 right upper, 3 left lower ''reverse'', and 7 left upper sleeve lobectomies with radical lymph node dissection. Eight patients underwent reconstruction of the pulmonary artery. There were 34 non-small cell lung cancers, 3 limited small cell lung cancers, 1 neuroendocrine large cell carcinoma, and 3 bronchial carcinoid tumors. N2, N1, and N0 diseases were found in 13, 12 and 16 patients, respectively. Post-operative morbidity and mortality were 14.5% (n=6) and 4.8% (n=2) (1 patient, 4%, after induction chemotherapy). The rate of postoperative anastomotic complications was 2.4% (n=1). Late bronchial stenosis developed in 3 cases, but all were successfully medically treated. Twenty-nine patients are still alive, 27 without evidence of disease. The overall 2-year probability of survival (Kaplan-Meier) was 59%. Induction chemotherapy did not influence postoperative morbidity/mortality (chi2 test: P=0.64/P=0.56). CONCLUSIONS: Continuous nonabsorbable suture for sleeve lobectomy is quick and technical easy to perform, with low postoperative morbidity/mortality; induction chemotherapy does not influence postoperative outcome in these patients.

Adult↗
PubMed2004

[The surgical treatment of obliterating artery disease of the lower limbs today].

A NEW ALTERNATIVE: Vascular surgery can benefit from the advantages of the laparoscopic method, despite major technical problems (approach and control of the aorta, clamping and suture for arterial repair). Laparoscopic surgery has been used for the treatment of occlusive atheromatous aortoiliac lesions. FROM A TECHNICAL POINT OF VIEW: The first phase of laparoscopy consists in controlling the aorta from the renal arteries up to the inferior mesenteric artery. Then the arterial repair phase starts with the introduction of the prosthesis that is sewn on the aorta assisted by laparoscopy and the branches are tunnelled up to the femoral arteries where they are anastomosed. REGARDING THE RESULTS: In 24 patients having undergone laparoscopic treatment of atheromatous aortoiliac lesions, this technique led to most encouraging results and appears to be an exciting alternative to traditional surgery in selected patients.

Anastomosis, Surgical↗