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At least 1,333 records · Page 74Linked to original sources
PubMed2005

Transoral obesity surgery: endoluminal gastroplasty with an endoscopic suture device.

BACKGROUND AND STUDY AIMS: Surgical creation of a small gastric pouch with a restricted outlet is a well-established option for the treatment of morbid obesity. This report describes initial experience with endoscopic transoral stomach partition using a newly designed suturing apparatus. MATERIALS AND METHODS: A fresh porcine stomach was placed in the Erlangen model. A prototype suture device, incorporating a curved needle and an intracorporeal tightening mechanism, was used in this procedure. A long fishing line was first introduced into the stomach, with the two ends left outside. The suturing device, premounted outside a standard gastroscope, was inserted into the stomach and delivered several stitches attaching the fishing line to both the anterior and posterior walls along the line for the stomach to be partitioned. Five throws of half-hitches were tied onto the fishing line extracorporeally and separately pushed into place, creating a gastric pouch just below the esophagogastric junction. A flexible sheath of 8 cm long was then put on one side of the fishing line and pushed into the stomach. Additional extracorporeal knots were tied on the fishing line, forming a restrictive ring at the outlet of the pouch. The ring was then anchored to the stomach wall with similar endosutures. RESULTS: The proximal gastric pouch, with an estimated volume of approximately 100 ml, was successfully created with a restrictive band at its outlet. All of the stitches were securely sutured, with consistent penetration of the muscular layer of the stomach wall. CONCLUSIONS: In a bench model, it is technically possible to accomplish transoral gastroplasty endoscopically with an intraluminal suturing device. Further live animal studies will be needed in order to confirm the efficacy and safety of this procedure before clinical application.

Animals↗
PubMedDate not supplied

Scissor-knot-pusher: an instrument for simplified laparoscopic extracorporeal knotting.

This paper describes the "scissor-knot-pusher," an instrument that greatly facilitates the execution of knot tying during laparoscopic operations. The instrument acts in essence as an extension of the surgeon's hand and, given its rigid structure, allows the surgeon full control of the process of knot tying. Additionally, after the knot has been tightened, it is possible to cut the suture without using a different instrument. As a result, this technical device simplifies knot tying and may help to reduce the frustration and the time often associated with intracorporeal suturing during laparoscopic surgery.

Humans↗
PubMed1988

[Right-sided hemicolectomy using a compression suture].

Results of rightsided hemicolectomy performed in 23 patients using the compression suture with the help of apparatus AKA-2 and apparatus NZhKA-60 supplied with silicon paddings are described. The use of compression sutures have considerably shortened the time of formation of anastomosis and large intestine stump and allowed to standardize the technical methods of the operation. The ideal union of the sutured intestinal walls, antiseptic condition of the operation, high hermetic property facilitated the healing of anastomoses and the stump by first intention. The proposed method gives better functional results due to advantages of the compression method of joining the tissues.

Adult↗
PubMed2006

Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is an effective treatment for severe obesity. However, many patients regain weight over time. The mechanisms for this are unclear, and several factors may contribute, including dilation of the gastrojejunal anastomosis. This study aimed to assess the feasibility of endoscopic gastrojejunal anastomotic tightening and to determine the effect of tightening on body weight. METHODS: Eight patients with significant weight regain and dilated gastrojejunal anastomosis after RYGB were included in this pilot study. Sutures were placed endoscopically at the rim of the anastomosis. When tightened, the sutures formed tissue placations, reducing the size of the anastomotic aperture. RESULTS: The average preprocedure body mass index (BMI) was 40.5, and the patients had regained a mean of 24 kg from their post-RYGB nadir. The average pouch length was 5.7 cm, and the average anastomotic diameter was 25 mm. The average postreduction diameter was 10.0 mm (68% reduction). Six of the eight patients showed weight loss (mean, 10 kg) at 4 months. Repeat procedures were performed for three patients who had lost 4, 5, and 9 kg, respectively with the initial procedure. After the second anastomotic reduction, the final diameters were, respectively, 14, 5, and 5 mm. The first patient did not have further weight loss. The remaining two patients showed a total weight loss of 19 and 20 kg, respectively, at 5 months. All 11 reductions were accomplished without significant complication. The average postreduction BMI was 37.7, and the percentage of excess weight loss was 23.4%. CONCLUSION: Peroral endoscopic suturing to tighten dilated gastrojejunal anastomoses appears technically feasible and safe. This procedure is associated with variable but significant weight loss, and preliminary results suggest that it may offer a new treatment option for postbypass weight regain in selected patients.

Adult↗
PubMed1992

Sutureless vasovasostomy: new technique using experimental microclip in rat model.

Standard microscopic suture vasovasostomy represents a challenge to many urologists. It is technically demanding, and requires two to five hours of operative time. In an attempt to decrease the technical demand and the time requirement, we report the use of a microvascular anastomotic clip and compare this microclip to a standard eight-suture nonstented technique and a six-suture stented technique using a hollow, absorbable 0.5-mm polyglycolic acid stent. The control group with suture required an average of 38.5 minutes per anastomosis for the nonstented group and twenty-two minutes for the stented group. The clip group required 7.6 minutes for the unstented vasovasostomy and 6.5 minutes for the stented vasovasostomy. We obtained a 91 percent patency rate for the stented clip group and 100 percent patency for the unstented clip group. In a rat vasovasostomy, the operative time as well as the inherent technical demand were significantly reduced.

Animals↗
PubMed2003

Brow or forehead fixation with sutures only: a preliminary communication.

Fixation of the brow, although not technically difficult, can be a time-consuming process. Screws, whether permanent or absorbable, are occasionally associated with minor undesirable problems. We present a technique of brow suspension that is quick, simple, and free of the problems associated with fixation to the calvarium. It involves the use of sutures only. A heavy PDS suture is passed (with the aid of an awl) from the dermis of the brow or forehead that needs to be fixed to the dermis of a small incisional wound located 5-8 cm away. This suture suspension technique has proven to be quick and easy to execute. It has provided satisfactory fixation of the forehead/brow without problems of suture reaction. The cost of calvarial screws has been eliminated. When brow or forehead fixation is necessary, suspension with sutures to the dermis of a more superior location is an excellent method to accomplish the task quickly and easily. Long-term follow-up of a large series of patients will be necessary to validate the initial impression of this new technique.

Eyebrows↗
PubMed1991

[Recent ruptures of the anterior cruciate ligament. Suture technique on a reinforcement ligament. Results of a 5 years' experience].

225 patients with acute rupture of the anterior cruciate ligament were operated upon with a knitted polyester synthetic ligament (Ligastic) reinforced by a suture of the anterior cruciate ligament remnant. Five technical points must respected during the implantation of the ligament: isometry, direction of the femoral and tibial tunnels, absence of abrasion of the ligament in the notch, tensioning of the synthetic ligament equal to the natural cruciate ligament, careful suture of the remnants of the ruptured anterior cruciate around the synthetic ligament replacement. The functional results, according to the rating system of ARPEGE, demonstrated 8.6 on the stability scale, 8.1 for pain, 8.7 for mobility; 87 per cent of the competitors were able to return to their sport at the same level. There were no cases of acute synovitis. The patients were separated into three groups for evaluation: Group I--More than three years follow-up. Group II--More than two years follow-up. Group III--Less than two years follow-up. An anterior drawer test of less than 5 mm was observed in 85 per cent of Group I, 88 per cent of Group II, and 87 per cent of Group III. A negative jerk test was noted in 92 per cent of Group I, 95 per cent of Group II and 95 per cent of Group III. These differences were not statistically significant. On follow-up, a Lachman test of less than 5 mm was found respectively in 37 per cent, 70 per cent and 79 per cent; this difference was statistically significant. The relatively mediocre results of the Lachman test in Group I led us to follow a more precise isometric method. Postoperative cases were reexamined and demonstrated that the artificial ligament had become covered with an oriented fibrous tissue. The long-term outlook also depended on a successful restoration of proprioception in the repaired remnant of the anterior cruciate.

Adult↗
PubMed2001

Sutureless vascular anastomosis: the VCS clip.

Non-penetrating, arcuate-legged clips facilitate vascular reconstructions and significantly reduce the incidence of anastomotic neointimal hyperplasia. Though originally developed as a microvascular-approximating instrument, by far the largest application has been for hemodialysis vascular access. Long-term studies comparing suture to clip for access creation have demonstrated the clear technical and biological superiority of the clip for this procedure. This "sutureless" vascular anastomotic technique is more demanding than conventional suturing, requiring precise vessel preparation and supervised training.

Anastomosis, Surgical↗
PubMed2004

Linear technique of laparoscopic Roux-en-Y gastric bypass.

The laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the most common procedure performed for treatment of morbid obesity in the United States. The technique reported in this chapter requires mastering of extra-corporeal and intra-corporeal laparoscopic suturing, but is safe, cost effective, and technically feasible. Use of the straight needle eliminates the challenge of proper needle orientation encountered with a curved needle. The linear technique is used to construct the gastrojejunostomy because it is time saving and relatively simple. An endoscopic ruler and bougie are used to ensure a consistent pouch size and alimentary limb length. This chaper demonstrates the use of preoperative preparation, and a meticulous surgical technique using the linear stapler, to perform a combined total of more than 1800 cases.

Anastomosis, Roux-en-Y↗
PubMed2005

Suture knot on the repair splint: a simple method to facilitate reconstruction of the sella turcica during endonasal endoscopic transsphenoidal surgery. Technical note.

Reconstruction of the sellar floor after pituitary tumor removal is sometimes difficult because the repair graft is difficult to handle in the narrow space. This is especially problematic if the endonasal endoscopic approach is used. The authors devised a technique to facilitate this procedure by placing a suture knot on the repair splint. This allows the material to be grasped securely with forceps and improves manipulation even within the narrow nasal cavity. This technique has proved useful when performing the endonasal endoscopic approach, and it is also expected to be useful when conducting the conventional sublabial transsphenoidal approach.

Endoscopy↗
PubMedDate not supplied

Laparoscopic coloanal anastomosis for low rectal cancer.

OBJECTIVES: Low anterior resection with hand-sutured coloanal anastomosis for low rectal cancer is technically feasible, and it does not compromise oncologic results. We describe herein the effectiveness of the operation in treating low rectal cancer by a laparoscopic approach followed by intraanal canal dissection. METHODS: From February 1999 to October 1999, we used a laparoscopic procedure to divide the inferior mesenteric vessels and to dissect downward into the pelvic cavity as low as possible. A purse-string suture 1-cm distal to the lower margin of the tumor was secured and transection of the rectum was performed circumferentially via the anal canal near the dentate line. The specimen was removed by the pull-through method and coloanal anastomosis was completed with hand suture. A protective loop ileostomy was fashioned. RESULTS: We operated on 8 patients (4 males) with low tumor localization (average 4-cm above the dentate line). The age ranged from 45 to 83 years, with a median age of 64. The average operation time was 210 minutes (150 to 360 minutes), and the average blood loss was 250 cc (minimal to 750 cc). No operative mortalities occurred, but 2 patients had minor anastomotic slough complications. The average hospital stay was 13 days (7 to 26 days). The postoperative pathologic stage was T2N0M0 in 4 patients, T3N0M0 in 2 patients, T2N1M0 in 1 patient, and T3N2M0 in 1 patient. No local recurrence or distant metastasis occurred during the median 14 months (12 to 20 months) of follow-up. CONCLUSION: Laparoscopic coloanal anastomosis combined with intraanal canal dissection is safe and technically feasible. The oncologic results seem not to be compromised, but need further evaluation.

Adenocarcinoma↗
PubMed2001

Transurethral suture cystorrhaphy for repair of vesicovaginal fistulas: evolution of a technique.

Technical difficulties in the initially described transurethral repair of vesicovaginal fistulas have led to several modifications in technique. In an uncontrolled trial, these modifications included the use of a suprapubic tract, along with an arthroscope for visualization of the fistula. A large-caliber port is passed per urethram for transurethral instrumentation access. New-generation laparoscopic needle driver technology markedly improves the ease of transurethral suturing. Three previously unreported vesicovaginal fistula patients have had successful resolution of their fistulas after undergoing transurethral repair. Small-diameter vesicovaginal fistulas in selected patients can be successfully repaired by a minimally invasive transurethral suture technique.

Adult↗
PubMed1975

[Selection of pancreato-intestinal anastomosis in pancreatoduodenal resection].

41 pancreatoduodenal resections with 11 lethal issues (26.8 plus or minus 7%) were analysed. In 21 cases an end-to-end pancreatointestinal anastomosis was employed, in 12 cases an end-to-side one with peritonization of a suture line with the jejunal wall after the A. A. Shalimov technic, but in 8 cases- the technic of pancreatojejunostomy elaborated by the author, an end-to-end side type enveloping the anastomosis with a cecal segment of the jejunum. This method of peritonization does not impede passage of the intestinal content, thus rendering unnecessary the production of enteroenterostomy. Suture divergency of the end-to-end pancreatointestinal anastomosis was noted postoperatively in 6 of 21 patients (28.6 plus or minus 10%). Whereas, among 20 pancreatojejunostomies with peritonization of sutures by the jejunal wall after the A. A. Shalimov technic or in the author's modification this complication was noted only in 2 cases (10 plus or minus 7%).

Duodenum↗
PubMed2004

Stapled coronary anastomosis with minimal intraluminal artifact: The S2 Anastomotic System in the off-pump porcine model.

OBJECTIVE: A reliable, easy-to-use, 1-shot anastomotic device will significantly push the barrier for less invasive coronary bypass surgery. The current study was designed to test the safety, efficacy, and early patency of a novel distal anastomotic device. METHODS: The S2 Anastomotic System (iiTech BV, Amsterdam, The Netherlands) was used in 10 consecutive pigs (73 kg) on a mild antiplatelet regimen. In each animal, the device was used to create an internal thoracic artery to left anterior descending bypass on the beating heart. The anastomoses were evaluated intraoperatively (n = 10), at 2 days (n = 2), and at 5 weeks (n = 8) by functional flow measurements, postmortem angiography, and histomorphologic examination. RESULTS: In all pigs, the S2 Anastomotic System rapidly created successful anastomoses at the first attempt (graft loading and coronary ischemia time: 1.2 +/- 0.3 minutes and 3.0 +/- 0.6 minutes) on target vessels of 1.6 to 2 mm inner diameter. There were no technical failures or anastomotic leaks requiring additional sutures. Both intraoperatively and at the time of death, ischemically induced peak hyperemic flow responses demonstrated widely patent bypasses, which were confirmed by postmortem angiography (FitzGibbon grade A, n = 10) and macroscopic evaluation (anastomotic orifice: 2 mm). Histomorphologic evaluation showed a normal healing response with negligible neointima covering the connector and limited streamlining repair tissue formation between the staple-like elements of the connector. CONCLUSIONS: The S2 Anastomotic System consistently created automated, fast, and reliable internal thoracic to coronary artery anastomoses on the porcine beating heart with excellent graft patency and healing characteristics at the 5-week follow-up.

Anastomosis, Surgical↗
PubMed1989

Autologous fibrin glue in full-thickness skin grafting.

Full-thickness skin grafts can be anchored to the recipient site using fibrin glue made from the patient's own blood and commercially available thrombin and epsilon aminocaproic acid. The technique works well for small grafts on irregularly contoured sites where suture fixation of a graft would be technically difficult. Full-thickness skin grafts anchored with autologous fibrin glue have been uniformly successful in 50 patients followed for a minimum period of four months.

Fibrin Tissue Adhesive↗
PubMed1995

Surgical workshop on liver surgery using isolated perfused livers in moulded casts of the upper abdomen.

The basic training in liver surgery on isolated perfused livers used at the workshop in the First Surgical Course of the Alps--Adriatic Hepatobiliary School is presented. The methods for the excision, preservation, perfusion and preparation of the liver are described, as is the manner of manufacturing the upper abdomen moulded casts, into which an isolated perfused liver is placed for training. The methods proved to be sufficiently successful, enabling participants to perform basic liver surgery like an intraoperative ultrasound investigation, as well as liver dissection techniques, liver suturing, segmental resection and even hepatectomy. Some technical improvements are proposed for future surgical workshops, such as washing out the blood from the liver, and a triple perfusion.

Abdomen↗