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At least 1,423 records · Page 79Linked to original sources
PubMed2002

Arthroscopic transhumeral rotator cuff repair: Giant needle technique.

An arthroscopic transhumeral rotator cuff repair technique is presented with which the same type of cuff repair can be performed as with an open standard procedure. After adequate arthroscopic subacromial decompression, a bone trough is made on the greater tuberosity and a hole is punctured with a sharp hook. A special bone-cutting needle with a suture (giant needle) is then passed through the skin and deltoid muscle in front of the acromion, through the torn tendon, the hole in the trough, and out through the lateral cortical surface through the deltoid and skin. The suture limbs are pulled out through the instrumentation portal and a sliding knot is made to close the defect. No hardware implants are used and the procedure is not technically complicated. During surgery only two thirds of the steps used for open repair were required. With experience, a large tear was repaired as well as with an open repair. The advantages of this technique are that the strength of cuff fixation does not rely on the quality of the bone in the greater tuberosity, there is no need for complicated suture passing techniques through the rotator cuff, and it offers the same fixation technique as the traditional open repair.

Adult↗
PubMed2006

The posterior-medial portal.

Repair of the posterior superior labrum usually involves placing an anchor posterior to the biceps attachment through an anterior-superior or Wilmington portal. Access to the posterior-superior labrum can be accomplished by establishing a portal medial to the posterior viewing portal. The initial posterior arthroscopic viewing portal is established slightly lateral to a traditional position to allow viewing of the posterior labrum and maintain separation from the posterior-medial portal. The suture anchor can be placed behind the biceps attachment through an anterior portal. The posterior-medial portal is started approximately 3 cm medial to the viewing portal with an 18-gauge needle. The needle is directed anterolateral into the intra-articular space under arthroscopic visualization to determine the appropriate course of the suture retriever. The needle is replaced with a sharp suture retrieval device. The suture from the anchor is pulled through the labrum to achieve a simple or mattress type repair. The suture is retrieved through the anterior-superior portal by finding it medial to the labrum. The sutures can be tied through the anterior-superior portal. The posterior-medial portal can be safely established with attention to technical considerations.

Arthroscopy↗
PubMed2026

Risk factors and management strategies for needle disengagement from the visual field in pediatric robot-assisted laparoscopic pyeloplasty.

OBJECTIVE: This study aimed to identify risk factors for suture needle disengagement from the visual field during pediatric robot-assisted laparoscopic pyeloplasty (RALP) and propose effective strategies for prevention and management. METHODS: A retrospective cohort study analyzed clinical data from 339 pediatric patients who underwent RALP for ureteropelvic junction obstruction (UPJO) at a single institution between August 2017 and December 2020. Patients were categorized based on the occurrence of needle disengagement from the visual field. Various patient demographics and surgical procedural factors were evaluated. Univariate and multivariate logistic regression, along with LASSO regression, identified independent risk and protective factors. RESULTS: Needle disengagement occurred in 38 (11.21%) of 339 cases. Multivariate logistic regression identified five independent risk factors for needle disengagement: use of a 3-mm auxiliary trocar (OR = 4.69, 95% CI: 1.98-12.53, P < 0.001), non-standard needle holder use (OR = 2.32, 95% CI: 1.04-5.18, P = 0.038), unshaped suture needles (OR = 3.16, 95% CI: 1.44-7.19, P = 0.005), simultaneous use of &#x2265;2 intra-abdominal sutures (OR = 2.46, 95% CI: 1.15-5.48, P = 0.023), and clamping the needle shank during withdrawal (OR = 3.42, 95% CI: 1.40-8.21, P = 0.006). Conversely, sufficient assistant experience (>10 cases) was identified as a protective factor (OR = 0.39, 95% CI: 0.18-0.88, P = 0.021). CONCLUSION: Suture needle disengagement from the visual field during pediatric RALP is associated with specific technical and instrumental factors. Implementing targeted strategies-such as mandating specialized needle holders, preoperative needle shaping, a single-needle workflow, prioritizing clamping the suture thread over the needle shank during withdrawal, and ensuring adequate assistant training-has the potential to significantly reduce significantly mitigate the risk of needle loss and enhance overall surgical safety in pediatric RALP.

Humans↗
PubMed2001

Comparison of argon-laser welded and sutured repair of inferior vena cava in a canine model.

BACKGROUND AND OBJECTIVE: Advantages of laser-welded microarterial anastomoses have been reported. However, whether laser repair of large veins is advantageous is not yet known. Argon-laser welding of inferior vena cava was therefore compared with conventional-sutured repair. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four adult mongrel dogs were used. Twelve inferior vena cavas were repaired using an argon laser and the rest using continuous sutures. Specimens were removed at 2, 8, 16, and 24 weeks after repair. Technical characteristics, cavographical findings, and results of histopathological study using light and transmission electron microscopy were compared. RESULTS: Procedure time did not significantly differ between the two groups. The sutured repair sites were narrower than those repaired by laser immediately after and at 2 and 24 weeks. Histologically, laser welding resulted from denaturation of collagen and mild healing occurred simultaneously with the disappearance of denatured collagen. By contrast, there was strong fibrotic reaction at sutured repair sites. CONCLUSIONS: These findings suggest that argon-laser repair of large veins is superior to continuous suturing.

Anastomosis, Surgical↗
PubMed1998

Endoventricular patch plasties with septal exclusion for repair of ischemic left ventricle: technique, results and indications from a series of 781 cases.

Most cases of left ventricular aneurysms undergo operation through resection of the exteriorized dyskinetic area with longitudinal suturing of the opening and this technique has been considered by cardiologists (Froehlich et al) to bring no improvement to the morphology and performance of the left ventricle. Some technical modifications have been adopted, such as the septal plicature (Cooley) or circular suturing of the opening (Jatene). Since 1984 our team has used an endoventricular patch, sutured over the contractile area and excluding the akinetic non-resectable scars, bringing a significant and calculable improvement to the left ventricular function. This technique of left ventricular reconstruction (LVR), called endoventricular circular patch plasty (EVCPP) has been already used on more than 750 patients (May 97). Clinical and echographic data for each case are completed by right catheterisation with measurement of the cardiac output, pulmonary arterial pressures (PAP) and programmed ventricular stimulation (PVS), in order to detect eventual ventricular tachycardia (IVT). During left heart catheterisation, the morphology of the left ventricle (LV) is studied on right and left anterior oblique incidences and the LV ejection fraction (EF) is checked globally (GEF) and especially in its contractile portion (CEF). After surgery, a hemodynamic study associated with a PVS, is carried out during the first post-operative month, and again after one year. Results were clinically satisfactory in more than 90% of cases (8.9% of NYHA III-IV), and in more than 90% of cases with ventricular arrhythmia with the hemodynamic persistent EF at one year, superior to the pre-operative CEF. Thus we have to propose the following indications: Elective: This ventricular reconstruction can be recommended for ventricular aneurysms or akinesias with angina, arrhythmias or attacks of cardiac insufficiency, when GEF > 30% and CEF > 40%. The operative mortality rate varies from 1,5 to 3%, which is better than allowing natural evolution. Mandatory: In emergency, when safe immediate circulatory assistance or a cardiac transplant is unavailable, LVR can give hope for survival to more than 80% of patients, whereas natural evolution is without hope. Finally the operative indication is uncertain in two contrasting circumstances: In asymptomatic patients when hemodynamic and angiographic examinations after myocardial infarction show left ventricular dyskinesia. If GEF is below 40% and CEF below 50%, it seems wise to propose LVR in order to prevent unfavourable evolution. In end-stage ischemic cardiomyopathies, if the EF is below 20%, CEF is below 30%, cardiac output is below 1.5 l, and the mean pulmonary pressure is above 25, then a cardiac transplant should be considered. EVCPP with septal exclusion is a safe technique and easily reproduced when associated with coronary revascularization as far as practicable, then EVCPP improves the ventricular function. When associated with sub-total endocardectomy, then EVCPP allows excellent control of VA.

Adult↗
PubMed1989

Synchronous bowel anastomoses.

A retrospective review of patients who underwent double bowel resections and synchronous anastomoses without ileostomy or colostomy was undertaken. The study goal was to determine whether there was an increased incidence of complications attributable to the presence of a second anastomosis. A total of 66 patients who met the criteria were identified and divided into two groups. Group A consisted of 30 patients who had had two colonic resections and two colonic anastomoses. In Group B were 36 patients who had undergone separate colonic and small-bowel resections with two subsequent anastomoses. The indications for primary resection were: 1) adenocarcinoma, 54 percent; 2) Crohn's disease, 26 percent; 3) diverticulitis, 11 percent; 4) "other" indications, 9 percent. The indications for the second resection were: 1) metastatic adenocarcinoma, 30 percent; 2) Crohn's disease, 26 percent; 3) synchronous bowel lesions, 18 percent; 4) adhesions and enterotomies, 14 percent; 5) "other" indications, 12 percent. Overall, there were four major complications (6 percent), and 11 minor complications (17 percent). The sole anastomotic leak occurred in a patient who had undergone a double colonic resection (3%). The other major complications were one death, one ureteral complication that required reoperation, and one early small-bowel obstruction. Minor complications included two wound infections (3 percent), three seromas (5 percent), three prolonged ileus (5 percent), and three urinary infections (5 percent). These results are comparable to the best results reported for patients undergoing single colonic anastomoses. The conclusion is that it is safe to perform synchronous anastomoses without diversion provided the following conditions are present: well-prepared bowel with minimal fecal soilage, an adequate blood supply, technically good anastomoses, and lack of tension on the suture lines.

Adenocarcinoma↗
PubMed2003

Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients.

Our first 100 patients and our second 100 patients who underwent a laparoscopic repair of incisional and ventral hernias were compared and evaluated. This analysis revealed that the second group was approximately 9 years older with more comorbid medical conditions. In all, 15% were incarcerated hernias, and 21% were recurrent. Seven operations were converted to the open repair because of adhesions in five patients and either a small or large bowel injury in two patients. There were no complications related to enterotomy. Older and more infirm patients in the second group did not significantly affect outcomes. The average size of the hernia defects was 111 cm2. The average size of the prosthesis was 257.5 cm2. Larger prostheses were used in the second group. With more experience, the recurrence rates have declined from 9% to 4%. The etiology of these recurrences differed in these two groups of patients. Removal of the prosthetic due to infection was a predictable recurrence in two patients. A new hernia below the original hernia has caused us to repair the entire incision that had the initial hernia. Only one technical failure was noted, due to fracture of the suture during transfascial placement and clamping of the suture. It is not recommended to grasp any suture that remains in the patient during this hernioplasty. Recurrences were reduced because of the use of an increased overlap of the biomaterial and the use of dual methods of fixation (tacks and transfascial sutures).

Adult↗
PubMed1996

Hair-braiding closure for superficial wounds.

A superficial scalp wound can be approximated by tying the hair on each edge of the wound, without shaving or using suture material. This technique is useful in selected patients with lacerated scalp wounds, and its technical details and indications are described.

Craniocerebral Trauma↗
PubMed2003

Fate of coronary ostial anastomoses after the modified Bentall procedure.

BACKGROUND: Introduction of the modified Bentall procedure with the button technique has reduced but not eliminated anastomotic complications in patients receiving a composite aortic conduit. Particularly the true incidence of coronary ostial complications such as stenosis, kinking or pseudoaneurysm formation needs to be assessed. METHODS: We reviewed 71 patients receiving a composite aortic conduit from November 1993 to November 1999 for chronic aneurysms (n = 51) or aortic dissection (n = 20), 12 of whom had Marfan syndrome. Patients were divided into two groups according to variations in the surgical technique. In group 1 (30 patients; 42%) the classic modified Bentall operation with the button technique was employed whereas in group 2 (41 patients; 58%) some technical modifications were added mainly consisting of a reinforcement suture joining the cut edge of the aortic wall and the prosthetic sewing ring and suture of the coronary buttons with an "endo-button" technique. To detect potential procedure-related complications particularly at the coronary ostia anastomoses follow-up included transthoracic two-dimensional echocardiography every 6 months and computerized tomographic angiography at 12 months or whenever indicated; in 20 patients a magnetic resonance imaging angiography and standard aortography with selective coronary angiography were also added. RESULTS: At a mean follow-up of 49 +/- 19 months anastomotic complications occurred in 4 patients (6%): in 2 a pseudoaneurysm developed at the distal aortic suture line and in 1 a pseudoaneurysm developed at the right coronary ostium after repair of acute aortic dissection; in 1 Marfan patient an aneurysm of the left coronary ostium developed. Such complications were unrelated to the two surgical techniques used in this series for reimplantaion of the coronary ostia. CONCLUSIONS: The modified Bentall operation is associated with an extremely low incidence of anastomotic complications particularly at the coronary ostia. More extensive use of new imaging techniques is desirable to assess the true incidence of such complications in patients receiving a composite aortic conduit.

Adult↗
PubMed1976

Technique for the coronary snake graft operation.

The use of one end-to-side anastomosis with side-to-side technique for all additional vein-coronary anastomoses has given continually good results and has been used in 227 of 411 patients undergoing vein graft operations, including all multiple graftings done since April, 1972. The operative mortality was 4.6%. Arteriography by the end of the third postoperative month has been obtained in 98.4% of the 377 eligible patients. It showed that 98% of the 304 side-to-side anastomoses were patent, with 289 (95%) having unrestricted communication with the aorta. The proximal segment was widely patent in 193 (97%) of the 200 patients with snake grafts having postoperative arteriography. The distal end-to-side anastomosis was patent in 176 (88%) of these 200 patients. The average was 2.3 unrestricted grafts per patient. These results are better than the patency rates of 89 and 87% obtained previously with single and Y-grafts, respectively. Technical details have been worked out for construction of suture lines, choosing the correct length for segments, obtaining a reliable proximal segment, routing grafts to multiple coronary branches, and removing air from the grafts.

Angiocardiography↗
PubMed2000

Transvaginal bone anchored sling.

INTRODUCTION: To describe a new technique for the treatment of stress urinary incontinence by the transvaginal creation of a sling anchored to the pubic bone. This technique is minimally invasive and easy to learn, with minimal morbidity and complications. TECHNICAL CONSIDERATIONS: Miniature bone screws with No. 1 polypropylene sutures attached to them and a battery-operated screw inserter are used for the fixation of a biocompatible fabric sling to the pubic bone. The procedure is performed transvaginally with no abdominal or suprapubic incisions. One screw is inserted on each side of the urethra into the pubic bone below the bladder neck. A tunnel is made submucosally between these two holes just below the bladder neck, and the sling is passed through it. Using the sutures on each side of the urethra, the sling edges are tied and pulled toward the pubic bone. The openings made in the vaginal mucosa are closed with absorbable sutures. CONCLUSIONS: This sling procedure is minimally invasive, safe, and effective. Further experience and longer follow-up are necessary to establish its role in the treatment of women with stress urinary incontinence.

Adult↗
PubMed2003

Mechanical digestive anastomosis: a new technique to make it easier, quicker and more reliable.

In digestive circular mechanical anastomosis, a purse-string suture is normally performed in order to ensure that the anvil is securely fixed in place. We present a new technique where an adjustable plastic belt is used instead of the purse-string suture for the same effect. The procedure has been used on 10 patients with esophageal and gastric carcinomas. There was no difficulty in performing the anastomosis in any of the cases. We believe the procedure is technically simple and safe, and provides a significant advance in automatic digestive suturing.

Anastomosis, Surgical↗
PubMed1992

[Pulmonary valvular agenesis treated with cryopreserved pulmonary homograft].

We report successful treatment of pulmonary valve agenesia with pulmonary stenosis and ventricular septal defect by infundibular resection, patch-closure of the VSD and implantation of a cryopreserved pulmonary homograft. Cases with mild to moderate hypoplasia of the pulmonary annulus are particularly well suited for direct pulmonary homograft implantation, while cases with severe hypoplasia and high right ventricular pressure after correction may be better treated with aortic homografts. Some technical aspects of homograft implantation (doing first the proximal suture, preserving the normal configuration of the valvular sinuses and using the subvalvular homograft tissue to enlarge the right ventricular outflow tract) may prevent significant valvular incompetence.

Cryopreservation↗
PubMed1990

[Mechanical staplers. Our experience].

The Authors report their experience concerning 237 stapled sutures performed during 93 gastro-intestinal operations. Intraoperative technical advantages are described and improved postoperative courses are outlined; in particular earlier recovery of intestinal function, minimal rate of complications and 11-day average post-operative stay are reported.

Adolescent↗
PubMed1988

A simplified scleral graft technique for covering an exposed orbital implant.

A simplified method of covering an exposed orbital implant is presented. Donor sclera is placed between Tenon's capsule and the spherical implant without dissecting any tissue planes between the conjunctiva and Tenon's capsule. Technical manipulations and bleeding are thereby minimized. Preplaced absorbable sutures in the periphery of the graft are externalized and tied to the anterior surface of the conjunctiva.

Adolescent↗
PubMed1985

[Long-term results of reversed venous femoro-popliteal bypass. Apropos of 151 cases].

Of 151 inversed autogenous vein grafting done in 137 patients for femoro-popliteal disease, 97 (65%) have been done for severe ischemia (rest pain or gangrene); others (35%) have been done for severe walking pain or popliteal and/or femoro-popliteal aneurysms. The follow-up is of 13 years. Hospital mortality was 5 (3,3%). Early failure is of 6%. Patency rate at 5 years is 60% and at 10 years 46%. The lower the anastomosis is done on the popliteal artery the better is the long-term patency rate. The worst results are in diabetic and younger patients. Technic of in situ vein grafting would have not allowed 26% of patients venous revascularization because of the poor condition of the saphenous vein, that the inversed technic permitted (on using internal + external saphenous, resection-suture, etc).

Adult↗