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PubMed1980

[Experimental microsurgery on submillimetric vessels: technic and results (author's transl)].

This experimental work presents the results of 180 submillimetric microvascular interventions performed on the carotid arteries and jugular veins of 130 white rats weighting 100-150 g each. End to end (54 cases), end to side (76 cases) anastomosis, repair of arteriotomies by microsutures (30 cases) or patch graft (20 cases) were performed on submillimetric vessels (0.5 to 0.8 mm). Rats were used as acute preparation (70 cases) for the development of technical skill but in 100 cases they were kept alive between 1 to 3 weeks and then operated again. The patency rate, confirmed by arteriographies in 32 cases, was about 92%. At the end of training all the microvascular surgical procedures, even the most sophisticated, were patent at 100 %. The discussion emphasizes some points of technic concerning the choice of micro-instruments, sutures and clips and the realisation of submillimetric micro-anastomosis.

Animals↗
PubMed1994

[Replantation of the ring finger].

Tearing of a finger caught by a ring or by another similar mechanism is a rare but spectacular accident. The lesions vary from simple cutaneous erosion to complete separation of the extremity, which is the most spectacular and most difficult to treat. Reimplantation techniques are now well developed and involve very long vascular by pass to perform sutures in healthy zones. The operation is thus technically difficult, it can have a favourable course in some cases whereas in others, despite the use of meticulous technique, it can lead to thrombosis and failure of reimplantation. Alternatives to reimplantation can nevertheless obtain an esthetic hand, by regularisation or by intracarpal osteotomy. However, it appears of interest in young, motivated patients to propose reimplantation using microsurgery.

Amputation, Traumatic↗
PubMed1997

[The intradermal cutaneous suture with separate stitches using a resorbable monofilament (Polyglecaprone 25)].

The introduction of sutures using Polyglecaprone 25 (Monocryl--Ethicon SpA) has facilitated the use of intradermal suture with separate stitches owing to its flexibility and softness, with extremely satisfactory aesthetic results. The authors report their experience regarding the use of this new material from May 1995 to April 1996 in 250 cases of intradermal suture with separate stitches. The paper also describes a few technical details and emphasis their advantages.

Adolescent↗
PubMed2002

Percutaneous endopyeloplasty: description of new technique.

PURPOSE: We present a novel technique of percutaneous endopyeloplasty, in which the conventional longitudinal endopyelotomy incision is precisely sutured in a horizontal Heineke-Mikulicz fashion through the solitary percutaneous tract, thus, achieving Fenger-plasty type of repair of the ureteropelvic junction. MATERIALS AND METHODS: Percutaneous endopyeloplasty was performed in 9 patients with primary ureteropelvic junction obstruction. Essential steps of our novel technique include retrograde placement of a ureteral catheter over a guide wire into the renal pelvis, establishing conventional percutaneous renal access, creating a conventional longitudinal endopyelotomy incision and performing full-thickness horizontal suturing of the endopyelotomy incision in Heineke-Mikulicz fashion. Suturing was done using the novel 5 mm. Sew Right 5 SR laparoscopic suturing device (LSI Solutions, Rochester, New York) passed through the nephroscope. RESULTS: Percutaneous endopyeloplasty was technically successful in all 9 patients. Mean total operative time was 100.8 minutes (range 62 to 140.), including an endopyeloplasty suturing time of 26.6 minutes (range 14 to 54.). We placed 1 to 4 endopyeloplasty sutures per case. Blood loss was minimal, mean hospital stay was 2.2 days (range 2 to 3) and the ureteral Double-J stent (Medical Engineering Corp., New York, New York) was removed in 2 weeks. At a mean followup of 4 months all operated kidneys showed relief of obstruction, as confirmed by clinical improvement in symptoms and improved renal drainage on excretory urography and diuretic renography. CONCLUSIONS: Percutaneous endopyeloplasty is technically feasible, safe and effective. Potential advantages over conventional endopyelotomy include wider caliber reconstruction of the ureteropelvic junction, full-thickness healing with primary intent, minimal urinary extravasation and shorter stenting duration. To our knowledge the initial clinical experience is presented.

Adult↗
PubMed1995

Advanced non-animal microsurgical exercises.

For the novice microsurgeon, suturing simple lines on a static model ill prepares them for the technically difficult live model that is to follow. A practice card was therefore designed to make the transition easier. The basic building block is rubber glove sutured to form a simple tube. From this point, progressive exercises are carried out. These are (1) simple suturing, (2) tube anastomosis, (3) end-to-end anastomosis, (4) end-to-side anastomosis, (5) side-to-side anastomosis, (6) inequality of diameters, and (7) free graft placement. Since the student is faced with problems that are challenging and progressively complex, a noticeable improvement is seen in their skills. These models introduce the student to planning and instrumentation that they would deal with in the clinical situation. Once the student has mastered these exercises, he/she is ready to advance to the rat model.

Animals↗
PubMed2000

The difficult gallbladder: technical tips for laparoscopic cholecystectomy.

Conversion of laparoscopic cholecystectomy to laparotomy may increase postoperative complications and convalescence and should therefore be avoided when possible. The authors present three technical tips that may prevent unnecessary conversion to open procedure (suspension sutures in the gallbladder, use of the Endo Paddle Retract (United States Surgical Corp., Norwalk, CT, USA) to depress abdominal viscera, and subtotal cholecystectomy). These methods may be used in situations in which there is no operative risk for complications, such as bile duct injury, but technical aspects of the operation normally would have resulted in conversion to laparotomy.

Cholecystectomy, Laparoscopic↗
PubMed1995

Sutured or fibrin-glued laparoscopic choledochojejunostomy.

Minimally invasive techniques for choledochojejunostomy offer theoretical advantages for palliating unresectable periampullary neoplasms. Fibrin glue, a biologic adhesive containing concentrated fibrinogen, may obviate suturing and promote healing without stricture formation. We examined the technical ability to perform laparoscopic choledochojejunostomy (LCJ) and the applicability of thrombin-activated fibrin glue in an animal model of biliary obstruction. Domestic pigs underwent laparoscopic cholecystectomy and ligation of the distal bile duct. Three days later, a side-to-side LCJ was performed by intracorporeal sutured anastomosis (n = 7) or using four stay sutures and homologous fibrin glue (n = 7). Control animals underwent a similar bypass via open laparotomy (n = 7). The postoperative interval to ambulation and oral intake was recorded, and serial serum liver enzymes were measured. The animals were sacrificed at 6 weeks, and tensile strength of the anastomoses was assessed by tensometry. Liver function tests returned to normal values within 7 days following all methods of choledochojejunostomy. In the fibrin glue group, three anastomotic leaks (43%) occurred in the 1st postoperative week. At 6 weeks, all other anastomoses were intact and patent by cholangiogram, but there was moderate stenosis of two open and one fibrin-glue anastomosis. The sutured LCJ, while taking approximately 1 h longer to perform (P < 0.05), resulted in similar efficacy and more rapid recovery (P < 0.05) than open biliary-enteric bypass. Fibrin-glued LCJ was performed rapidly, but had less tensile strength (P < 0.05) and often leaked in the early post-operative interval. We conclude that while there may be a role for laser-activated solders for primary anastomosis, thrombin-activated fibrinogen cannot be advocated as the primary means of creating biliary anastomoses. Using intracorporeal suturing techniques, laparoscopic choledochojejunostomy may be performed safely.

Alanine Transaminase↗
PubMed2001

Arthroscopic shoulder stabilization with suture anchors: technique, technology, and pitfalls.

Arthroscopic treatment of anterior shoulder instability has evolved significantly during the past decade. Currently, most techniques include the use of suture and suture anchors. A successful outcome is highly dependent on accurate patient selection. Preoperative evaluation, examination with the patient under anesthesia, and defining the pathoanatomy by a thorough arthroscopic examination determine the most effective treatment strategy. Technical skills include the surgeon's ability to accomplish anchor placement, suture passage, and arthroscopic knot tying. Various instruments and techniques are available to facilitate arthroscopic reconstruction. In properly selected patients and with good surgical technique, outcomes should approximate or exceed traditional open stabilization techniques.

Arthroscopes↗
PubMedDate not supplied

Closure of the abdomen by mesh for planned re-laparotomy. A technical modification.

Temporary closure of the abdomen with a synthetic mesh and multiple planned relaparotomies are the essentials of the modern strategy for treating severe intra-abdominal sepsis or pancreatic necrosis. One of the complications associated with mesh closure of the abdomen is facial necrosis at the wound edges leading to evisceration. Tension of the strictures between mesh and facia called local ischemia, which combined with infection leads to the facial disintegration and separation of the mesh from the abdominal wall. A modified technique of suturing the mesh was developed in our department and its technical details are presented. Twenty-four patients treated with the "open abdominal technique and planned relaparotomies" are presented. The new technique was used in 9 patients for closure of evisceration after mesh separation.

Adult↗
PubMed1988

Further technical considerations of the sleeve microanastomosis.

In sleeve anastomoses, stenoses at the suture site have been the main concern. Mechanical dilatation is one way to prevent the stenosis, as suggested by Lauritzen. In the present study, 50 vessels (femoral and carotid) and 10 veins were used for sleeve anastomoses and the same numbers of vessels were used for conventional anastomoses (as control) to evaluate the effect of mechanical dilatation using resin corrosion cast (Mercox) because the Mercox cast facilitates three-dimensional stereoscopic views. Gradual dilatations around the suture sites were observed in seven carotid arteries, and three of seven resulted into aneurysm formation due to weakening of the inner vascular wall in the sleeve anastomosis. No dilatation or aneurysm was observed in the femoral arteries. Newly proliferating capillaries formed on the endothelial surfaces of the inner vascular walls around the suture sites after 4 weeks in the sleeve anastomoses. Operative time and endothelial trauma were markedly reduced with sleeve anastomoses. The gradual dilatation and aneurysm formation in the carotid arteries show that sleeve anastomoses should be used carefully for high-pressure arteries in clinical practice if mechanical dilatation is performed.

Anastomosis, Surgical↗
PubMed1979

[Transplantation of the kidney in the rat. I. Problems of surgical technic].

Is described a technique for transplanting rat kidneys. The technique involves suture of vessels of less than 1 mm in diameter with microsurgical techniques. Were used adult male rats of wistar strain. The kidney is perfused with 250 cc of ringer lactate, heparin 10.000 U.I., solumedrol 1 g novocain 150 mg. The results were very good.

Animals↗
PubMed1996

A simple method of closure of a laparoscopic trocar site.

Trocar site herniation is a recognized complication of laparoscopic surgery. Omental herniation, and more importantly small-intestinal herniation with incarceration and obstruction, has been documented in surgical literature, occurring particularly at the large trocar sites (> or = 10 mm) that were not sutured at operation. Secure closure of the trocar site fascial wound is often technically difficult, being hampered by the limited size of skin incision, the depth of the subcutaneous fatty layer, and the concern about placing deep sutures blindly after the abdomen has been decompressed. We describe a simple technique to effect this closure securely and safely, and briefly discuss its other applications and limitations.

Humans↗
PubMed1998

A muscle-clamping system with an absorbable jaw clip to reduce suturing in strabismus surgery.

Most of the ocular complications of strabismus surgery are related to needle trauma during the suturing of muscles. The authors have developed a muscle-clamping system with an absorbable jaw clip to facilitate exact techniques of eye muscle surgery and to reduce the risk of complications. The absorbable jaw clip is composed of a lower fixing body with three jaws and an upper supporting body. The clip is used to tie an extraocular muscle (which is moved and reattached with the membrane) with a single scleral bite. Using the absorbable jaw clip, the authors performed superior rectus recession on 16 eyes of eight rabbits. The authors examined the conjunctival injection, muscle adhesion power, and light microscopic findings at 1, 2, 4, and 8 weeks postoperatively. The conjunctival injection diminished with time. Bond strengths ranged from 380 to 620 gram gravity, which is sufficient to withstand the normal pull of human extraocular muscles. Some inflammatory cells were found microscopically, and fibrosis increased with time. The muscle-clamping method with the newly invented clip was technically easy, fast, and exact, and it may reduce suturing and complications during strabismus surgery.

Animals↗
PubMed2001

[Dorsal V-ligament reconstruction in scapholunate instability].

In dynamic and static scapholunate instability after trauma, the repair of the scapholunate ligament is important to avoid scapholunate advanced collapse of the wrist. Direct suture even of fresh-torn ligaments can be technically demanding and occasionally unreliable, thus reconstruction may require additional tissue beside the ligament. Eighteen patients suffering from dynamic (n = 10) and static (n = 8) scapholunate instability were treated by a dorsal ligament reconstruction six months after trauma. A clinical wrist score according to Cooney showed an average of 86 points (maximum 100) within a follow-up of nineteen months after surgery. X-ray films documented no significant loss of scapholunate reduction. Using local tissue only, this method is always possible, very reliable and easy to perform.

Adolescent↗
PubMed1994

Flexistap BC: a new flexible circular stapler for endoscopic surgery.

This article presents a new stapler characterised by a flexible arm and interchangeable cartridges. The stapler's flexibility and availability in different lengths up to 60 cm permits the placing of sutures even at significant distances from the point of entry; furthermore it is possible to perform more sutures on the same patient by replacing the cartridges. The author discusses the technical features of the instrument in detail.

Anastomosis, Surgical↗
PubMed1988

[Ulcerated cancers of the breast: results of modified mastectomy. Apropos of 64 cases].

Although, happily, at the present time the actual tendency in mammary neoplastic disease is being increasingly orientated towards conservative treatment, a fairly large number of total mastectomies are still being performed in patients diagnosed at a late stage. The frequency, technical aspects and precise local and general prognosis of this affection are discussed in relation to 63 breast cancers treated surgically between 1975 and 1984. These so-called "trimming" mastectomies represent 4.22% of overall total mastectomies performed during the same period. The surgical technic employed was the Patey type total mastectomy with either primary suturing after-wide separation of borders or closure with a thoraco-epigastric fasciocutaneous flap with internal pedicle. Actuarial survival was satisfactory: 58% at 2 years, 34% at 5 years, survival being significantly better in patients with lack of glandular invasion. This surgical technic should be considered, in combination with other therapy, for these patients, who should not be classed as "unrecoverable".

Adult↗