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At least 1,369 records · Page 76Linked to original sources
PubMed2003

Feasibility of laparoscopic partial nephrectomy using pledgeted compression sutures for hemostasis.

PURPOSE: To develop a technique for laparoscopic partial nephrectomy (LPN) without the use of hilar occlusion that allows large renal resection and excellent hemostasis. MATERIALS AND METHODS: Five female domestic pigs underwent right laparoscopic transperitoneal lower-pole partial nephrectomy after placement of pledgeted parenchymal compression sutures tied intracorporeally to induce regional renal hypoperfusion. Postoperatively, serial serum creatinine measurements were obtained to monitor renal function. The pigs were allowed to recover and 2 weeks later underwent an identical procedure on the left side. The animals were sacrificed after the second procedure, and both renal units were removed for ex vivo retrograde urograms and histologic analysis. RESULTS: The median operative time was 154.5 minutes (range 110-305 minutes), and the median blood loss was 137.5 mL (range 100-300 mL). On average, 35% (range 31%-36.8%) of the kidney was resected. All cases required use of adjunctive hemostatic clips to control bleeding from central vessels. All animals survived 2 weeks and had no evidence of urinary extravasation clinically or on ex vivo retrograde urograms. CONCLUSIONS: In the porcine model, LPN with placement of pledgeted sutures allows resection of large renal segments, although technical refinements are required to improve hemostasis. Currently, the need for adjunctive hemostatic measures limits the initial clinical application of this technique to small, exophytic tumors.

Animals↗
PubMed2001

[Percutaneous transfemoral implantation of a new, flexible thoracic aorta endoprosthesis using a percutaneous suture system for vascular suture--initial experiences].

PURPOSE: To evaluate the transfemoral placement of a new, flexible stent-graft into the thoracic aorta and the suture-mediated closure of the femoral access. PATIENTS AND METHODS: Five patients were treated endovascularly with a stent-graft for an aneurysm (n = 3) or acute dissection (n = 2) of the thoracic aorta via a femoral 24 F sheath. The femoral access site was closed with two suture-mediated closure devices after placement of the stent-graft. RESULTS: The aneurysm or the false lumen was excluded from perfusion by the placement of the stent-graft in all patients. Hemostasis at the femoral access site was successful in all patients with the percutaneous suture device. A minor stenosis of the femoral artery was found angiographically in four patients after suture-mediated closure. Besides a reversible renal failure due to the medically induced hypotension for the treatment of an acutely ruptured aneurysm, no complications resulted from the stent-graft placement or the percutaneous suture. CONCLUSION: The percutaneous transfemoral placement of stent-grafts in the thoracic aorta using a suture-mediated closure of the access site is technically feasible. Long-term results of the technique have to be awaited.

Aged↗
PubMed2000

Five-year experience with a suture annuloplasty for mitral valve repair.

We present five years' experience with mitral plication annuloplasty, performed with a semicircular buttressed suture around the posterior leaflet in 130 patients (mean age 58 +/- 11 years) with primary mitral valve disease (n = 71) or functional mitral regurgitation (n = 59). In 65 cases the mitral valve itself was also repaired. Concomitant myocardial revascularization was performed in 40 cases and aortic valve replacement in 43. All but three patients were followed up (97.6%). Postoperative echocardiography showed acceptable mitral area (2.28 +/- 0.39 cm2) and good valve competence in all cases. Inhospital mortality was 3% and late mortality 4.8%. During the follow-up period (22.8 +/- 10.9 months) 8 patients (6.6%) required mitral valve replacement because of progression of native valve disease (n = 4), technical failure (2) or expansion of the annuloplasty suture (2). Mitral annuloplasty thus can be performed simply and with good results, using a strong, non-stretchable buttressed suture. This procedure can be an inexpensive alternative to ring implantation.

Aged↗
PubMed1983

[Pathophysiologic aspects, progressive and new developments in absorbable fully synthetic suture materials].

Polyglycolic acid (PGA) sutures and Polyglactin-910 sutures show only minimal tissue reaction, nearly no scar formation and no immunological reactions. PGA sutures of the third generation have the same advantages, but surgical handling is to much improved that they may be technically employed in unfavourable locations, e.g. gastrointestinal tract and respiratory organs. PGA sutures of the third generation and the new monofil Polydioxanon suture need special knot techniques.

Absorption↗
PubMed1975

Abdominal wound disruption.

Abdominal wound disruption occurred in 6 cases in a series of 2500 consecutive abdominal laparotomies. A prospective study of 900 laparotomies utilizing polyglycolic acid suture material and the Smead-Jones closure technic was carried out over a period of 1 year with a reduction in the incidence of wound disruption from 0.4 to 0.1%. Etiologic factors placing patients in a high-risk category for disruption are identified, and specific prophylactic measures are discussed. Prevention of catastrophic disruption is advocated because of its high mortality rate, averaging 20%.

Adult↗
PubMed2002

Lichtenstein inguinal herniorrhaphy using sutures versus tacks.

The Lichtenstein hernia repair has become a popular technique for most inguinal hernias performed in the United States. One attempt to improve on this technique includes the use of a tacker instead of suturing the mesh. This study compared the feasibility and time saving for placement of mesh for open inguinal hernias with a tacker versus polypropylene suture.Thirty-four patients were prospectively randomized to undergo open hernia repair using either running 2-0 polypropylene suture or a tacker device that contained spiral titanium tacks. Patients were examined after 1 week and followed for a mean of 8 months (range 1-26 months) to record postoperative complications and technical failure rate. Mesh placement times were significantly shorter in the tacker group (9.0+/-3.5 min) than the suture group (30.9+/-9.9 min). No technical complications or recurrences were found in the follow-up period in either group.Securing mesh with the tacker is safe, and repair appears durable at short-term follow-up. Using the tacker on open inguinal hernia repairs shortens the time for mesh placement compared to suture fixation. Decreased operative time may reduce overall cost.

Adolescent↗
PubMed1975

[Treatment of injuries of the tendons of digital flexors].

An experience with functional and physical and physical therapy employed postoperatively in 525 patients with injuries of 752 digital flexor tendons is reported. A primary suture on flexor tendons after the V.I. Rozov technic within the boundaries of the synovial-aponeurotic sheath was put on 252 fingers in 183 patients. Homoplasty of digital flexor tendons was performed in 342 patients (500 fingers), terms of the injury being from 2 months to 15 years. Studies of late results in 382 patients on 535 fingers enabled to conclude that along with an operative procedure one should provide the conditions for an early functioning of the muscle and operated tendon per se. Therapeutic exercises associated with massage, physical and labour therapy seem to be a decisive factor in the complex of postoperative measures.

Adolescent↗
PubMed2000

Comparison of titanium vascular closure staples with suture repair of the thoracic aorta in swine.

OBJECTIVE: Devices that reduce technical difficulty and anastigmatic time when repairing large vessels such as the thoracic aorta would be beneficial. The aim of this study was to determine if titanium vascular closure staples (3 mm) could be safely and quickly applied in the repair of large vessels such as the thoracic aorta. DESIGN: Through a left thoracotomy in 10 female swine (110 to 130 lb), an interposition graft (14 to 16 mm textile) was placed into the aorta distal to the left subclavian artery. Animals were randomized at the time of repair to either running sutures (n = 5; 6-0 polypropylene) or vascular closure staples (n = 5; 3 mm). The anastomosis was evaluated after 2 months with aortograms, and the aorta was harvested to evaluate healing. RESULTS: The clamp times (mean +/- SD) were 30.8 +/- 8.2 min for suture repair and 24.8 +/- 5.1 min for vascular closure staple repair (p = 0.2). Anastomosis times were 20. 0 +/- 6.2 min for the suture group and 16.4 +/- 6.4 min for the vascular closure staple group (p = 0.4). Arch aortograms at 2 months revealed no significant difference in luminal narrowing between the two groups. Gross and microscopic examination revealed no thrombosis, well-healed wounds with a continuous intimal layer, and no differences in intimal thickness or inflammation between the two groups. CONCLUSION: Vascular closure staples were equivalent to sutures in terms of durability, graft patency, and wound healing at 2 months. Vascular closure staples may offer the trauma surgeon a quick and easy alternative when repairing large vessels such as the thoracic aorta.

Anastomosis, Surgical↗
PubMedDate not supplied

[Achilles tendoplasty (original technic and results)].

The technique consists in an intra-tendinous suture with two thick cotton strands, and in surrounding these strands with the tendon of the small plantar muscle. The entire assembly is coated with a square tendinous flap obtained from the tendinomuscular junction and sutured to itself just like a muff. From the first application of the technique in 1960 to the present a total of 38 cases have been solved, of which 29 have been followed at intervals between 2 and 19 years. The good results that have been obtained justify the interest of the technique. A series of considerations are made on the biomechanisms that induce the lesion, on the macroscopic aspects, and on the microscopic and microangiographic ones.

Achilles Tendon↗
PubMed1975

Palliative treatment of complete transposition of the great vessels: First clinical results of closed atrial septectomy with new septectome.

Our initial method of closed atrial septectomy, used in the palliative therapy of transposition of the great arteries (TGA), failed to produce a technical success in 1 of 5 patients. Subsequently, we modified the technique by securing the septum on traction sutures and simplifying the introduction of the septectome. With the new method, we achieved technical success in all 13 patients so treated. In our total of 18 patients treated by closed atrial septectomy, 7 had TGA with no other cardiac anomaly, and none of the 7 died. Of the remaining 11 patients who had TGA and other cardiac anomalies and required procedures such as ductus ligation, pulmonary artery banding, and aorta-right pulmonary artery shunt in addition to septectomy, 5 died. In only 1 of them, death was caused by technical complications with our initial method. Of the remaining four deaths, two were due to pre-existing cerebral damage and two to complications of palliative procedures done in conjunction with atrial septectomy. Side-to-side anastomosis between the superior vena cava and right pulmonary artery, carried out successfully in 1 case, is suggested as an additional palliative measure to supplement atrial septectomy in TGA.

Cardiac Surgical Procedures↗
PubMed2004

Single-layer continuous suturing for end-to-end colonic anastomosis using a modified closed-bowel technique.

We describe our modified technique of performing one-layer continuously sutured colonic anastomosis, which we introduced in 1995. We also present the preliminary results of performing end-to-end intra-abdominal colonic anastomosis constructed by single-layer continuous suturing using the closed-bowel technique in 106 patients. Mortality was 2.8%, the incidence of early postoperative surgical complications was 3.8% [including anastomotic leakages (1.9%)], and the rate of reoperation for infective complications was 2.8%. These positive results show that this is an effective method of performing end-to-end colonic anastomosis. We think that our technical modification provides advantages for one-layer continuously sutured colonic anastomosis.

Adult↗
PubMed2007

Treatment of renal transplant complications with a mesh hood fascial closure technique.

Early renal allograft dysfunction may be caused by a number of technical factors including thrombosis, kinking of vessels, and a Page kidney situation in which the allograft is compressed within a shallow false pelvis and limited retroperitoneal space. Without early recognition, compromised graft function, obstruction, or graft loss may ensue. We describe a technique using a polypropylene-assisted mesh hood fascial closure (MHFC) to prevent and treat this potential complication. MHFC was performed both primarily to prevent this phenomenon, and secondarily to treat this complication. Between April 2001 and October 2002, 16 patients undergoing 17 renal transplants underwent MHFC. The mean recipient body weight was 17% less than the mean donor weight. The mean follow-up period was 9 months. The mean serum creatinine level after primary MHFC was 148.4 micromol/L. Three of 4 patients with early allograft dysfunction regained function after secondary MHFC and had a mean serum creatinine level of 155.3 micromol/L. Wound complications were seen in 5 (31%) patients with no wound or mesh infections and 1 patient was diagnosed with a lymphocele. We conclude that the use of mesh in the primary closure of the incision after renal transplantation is safe and has minimal complications.

Compartment Syndromes↗
PubMed2001

Plastic surgery at the time of membrane removal around mandibular endosseous implants: a modified technique for implant uncovering.

Removal of barrier membranes may complicate second-stage implant surgery, particularly in mandibular areas characterized by a shallow vestibule and minimal amount of keratinized tissue. A new surgical technique that permits implant exposure and membrane removal combined with a plastic procedure to improve soft tissue quality both buccally and lingually is presented. A midcrestal incision preserving the keratinized tissue available on the lingual side is designed. A double-layer flap is elevated, allowing membrane removal. The inner, full-thickness layer is then sutured back into place, thus protecting the regenerated bone and allowing a recipient bed for a free gingival graft. The outer, partial-thickness flap is sutured apically, thus deepening the vestibule. The advantages and technical aspects of the procedure are discussed.

Bone Substitutes↗
PubMed1992

Minimal suture blepharoplasty: closure of incisions with autologous fibrin glue.

Blepharoplasty incisions can be cloned safely with autologous fibrin glue. The fibrinogen, prepared either from a whole-blood or plasmapheresis source, is mixed with commercially available thrombin to form a seal that is both hemostatic and adhesive. The complication rate is low and primarily due to technical factors in the initial cases. When compared with standard suture techniques, the incidence of minor problems such as milia formation was much lower. In select cases, the technique of using fibrin glue and a minimal number of sutures may be useful as an alternative method of wound closure in blepharoplasty patients.

Eyelids↗
PubMed1999

[Gynecological interventions and cesarean section without suturing of the peritoneum (visceral and parietal)].

The authors reveal advantages of sewing off technics of parietal and visceral peritoneum in gynaecologic operations and Caesarean sections compared with common routine technics of sewing up. This study is prospective, controlled and includes two years period. 170 cases of gynaecologic operations and 45 Caesarean sections are investigated. It is confirmed the role of preoperative microbiologic investigations of cervical secret and vaginal secret. On the base of results similar to world experience in this field authors recommend described technics to gynaecologists and obstetricians.

Cesarean Section↗
PubMed2004

An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence.

Numerous ways to attach an anterior cruciate ligament avulsion from tibial eminence have been devised, and this report is the first of its kind to describe an easy but effective way of passing nonabsorbable braided sutures through the substance of the anterior cruciate ligament and hold down the avulsed bone fragments by tying knots over a bone bridge.

Anterior Cruciate Ligament↗
PubMed2004

Arthroscopic Bankart repair in the beachchair position: a cannulaless method using an intra-articular suture relay technique.

In shoulder arthroscopy, cannulas with large diameters (7-9 mm) are commonly used both in the lateral decubitus and the beachchair position because they ensure the easy introduction of instruments into the intra-articular space and provide a clear arthroscopic view through the application of high intra-articular pressure. On the other hand, fluid extravasation and the resulting inconvenience due to the narrowing of the intra-articular working space are also obvious issues. Consequently, this makes arthroscopic stabilization surgery all the more challenging. To avoid these shortcomings of this procedure, we believe cannulas should be used only when necessary such as for knot tying and for transtendon portals. In this article, we report a unique and original method of arthroscopic Bankart repair in the beachchair position with limited use of cannulas of smaller diameter (5 mm) and its advantages over ordinary arthroscopic techniques using large-diameter cannulas in terms of preventing fluid extravasation and keeping a wide working space, which facilitates beneficial intra-articular techniques.

Arthroscopy↗
PubMed2004

Simplifying arthroscopic suture retrieval with a knot pusher.

The author describes a technique for simplifying suture retrieval during arthroscopic procedures. During retrograde suture retrieval, it might be difficult to grasp sutures unless the suture is brought to the retrieving instrument. If the surgeon does not have an assistant with arthroscopic experience, guiding the suture to the retriever could be impossible. Using a closed-end knot pusher, the assistant can easily deliver the suture to the retriever. This technique allows even the least experienced arthroscopists to assist with suture retrieval.

Arthroscopy↗