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At least 1,531 records · Page 85Linked to original sources
PubMed2005

A novel minimally occlusive microvascular anastomosis technique using a temporary intraluminal shunt: a prospective technique to minimize brain ischemia time during superficial temporal artery-to-middle cerebral artery bypass.

OBJECTIVE: To describe a new technique of suturing microvessels with persistent perfusion via a temporary intraluminal microshunt. METHODS: Experiments were conducted in Wistar rats. Abdominal aorta grafts were explanted from donor rats. A soft silicon microcatheter was introduced into the lumen of this graft. The abdominal aorta of a recipient rat was prepared for end-to-side microvascular anastomosis. Acland clamps (S&T AG, Neuhausen, Switzerland) were applied, and a linear arteriotomy was made. One end of the graft-clad microcatheter was introduced into the lumen and occluded with a fenestrated Acland clamp. At a more distal part, a similar arteriotomy was performed, and the other end of the microcatheter was introduced into the lumen and clamped with a fenestrated Acland clip. This created a temporary shunt through the graft-clad microcatheter. Then, the graft was anastomosed to the arteriotomies at both ends, over the microcatheter, in an end-to-side manner. The microcatheter was explanted from the vessel lumen through an arteriotomy in the middle of the graft. The graft was clipped short to close this arteriotomy. The mean total occlusion time before perfusion was reestablished amounted to 3.7 minutes. This experiment was repeated in 12 animals (6 with and 6 without heparin) without technical complications. As controls, conventional anastomoses were made in 2 animals. RESULTS: Suturing microvessels mandates their occlusion during the period of anastomosis. Although ischemia is well tolerated by other tissue types, the brain is quite sensitive to even short windows of ischemia. Nonocclusive anastomotic techniques have been developed recently. These are confined to vessels with luminal diameters greater than 3 mm. We have evolved a novel technique that can be used with microvessels, as pertinent to superficial temporal artery-to-middle cerebral artery bypass. CONCLUSION: We have described a new technique for performing microvascular anastomoses over a temporary intraluminal microcatheter shunt.

Anastomosis, Surgical↗
PubMed1990

In search of the "perfect" anastomosis.

Forty-five end-to-side microvascular anastomoses were completed in rat carotid arteries of 0.7-0.8 mm diameter (anastomosing the distal end of the left common carotid to the side of the right common carotid). For comparison both 10-0 and 11-0 sutures were utilized in different anastomotic techniques: interrupted, direct-continuous, and diagonal-continuous sutures, plus total mural thickness vs. partial mural thickness (piercing only the adventitia and outer media, excluding the intima). Anastomoses were evaluated for patency and scanning electron microscopic appearance after 10 to 12 weeks. The results indicate complete patency in all anastomoses. Ultrastructural observations revealed nearly normal intimal appearance in the partial medial technique and only minimal evidence of intimal injury in the other techniques. It is concluded that 100% patency can be obtained regardless of suture size or anastomotic technique. The most important factor in anastomotic patency is the operator's technical skill.

Anastomosis, Surgical↗
PubMed1996

Thoracic laminoplasty using spinous processes--technical note.

A simple method of thoracic laminoplasty using spinous processes is described. The procedure involves reshaping the spinous processes which have been removed during laminectomy and suturing these back into position to provide a cover for the dura. The procedure was carried out in five patients with good results. Laminoplasty using spinous processes appears to be a simple and safe alternative, using otherwise discarded tissue and requiring no sophisticated instrumentation, prosthetic material, or technically complex maneuvers.

Adult↗
PubMed1998

Hepaticojejunostomy without suture.

Common bile duct (CBD) surgery sometimes demands performing 'a la Roux' hepaticojejunal anastomosis. This kind of stoma is technically easy to perform on a biliary stump of sufficient width (> 8 mm), sufficient length (> 0.5 cm) and with a resilient wall so that stitches will not cut off. In some cases, however, the anatomical conditions are poor: short or thin biliary stump. This situation is especially encountered in iatrogenic lesions of the main biliary channel, but it can infrequently be found in some malignant lesions of the CBD. The authors present their procedure of hepaticojejunal anastomosis without suture, which is adequate for the treatment of benign or even malignant stenosis of the CBD. The method realizes anastomosis of the segments without using sutures by simply keeping them in apposition with continuous traction exerted via a Foley-type balloon catheter which stents the anastomosis in an axial manner. The balloon is then inflated and traction is exerted on the catheter, enabling the two segments of the anastomosis to remain in place until complete healing (10 days average). We performed the procedure in 7 cases: 4 for neoplastic stenosis, and 3 for an accidental lesion of the CBD. There was no perioperative morbidity and 1 fatal outcome. The results prompt further evaluation of the method.

Anastomosis, Surgical↗
PubMed2005

Construct validation of the ProMIS simulator using a novel laparoscopic suturing task.

BACKGROUND: The use of simulation for minimally invasive surgery (MIS) skills training has many advantages over current traditional methods. One advantage of simulation is that it enables an objective assessment of technical performance. The purpose of this study was to determine whether the ProMIS augmented reality simulator could objectively distinguish between levels of performance skills on a complex laparoscopic suturing task. METHODS: Ten subjects--five laparoscopic experts and five laparoscopic novices--were assessed for baseline perceptual, visio-spatial, and psychomotor abilities using validated tests. After three trials of a novel laparoscopic suturing task were performed on the simulator, measures for time, smoothness of movement, and path distance were analyzed for each trial. Accuracy and errors were evaluated separately by two blinded reviewers to an interrater reliability of >0.8. Comparisons of mean performance measures were made between the two groups using a Mann-Whitney U test. Internal consistency of ProMIS measures was assessed with coefficient alpha. RESULTS: The psychomotor performance of the experts was superior at baseline assessment (p < 0.001). On the laparoscopic suturing task, the experts performed significantly better than the novices across all three trials (p < 0.001). They performed the tasks between three and four times faster (p < 0.0001), had three times shorter instrument path length (p < 0.0001), and had four times greater smoothness of instrument movement (p < 0.009). Experts also showed greater consistency in their performance, as demonstrated by SDs across all measures, which were four times smaller than the novice group. Observed internal consistency of ProMIS measures was high (alpha = 0.95, p < 0.00001). CONCLUSIONS: Preliminary results of construct validation efforts of the ProMIS simulator show that it can distinguish between experts and novices and has promising psychometric properties. The attractive feature of ProMIS is that a wide variety of MIS tasks can be used to train and assess technical skills.

Clinical Competence↗
PubMed1978

The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis.

Performance of gastrointestinal anastomosis by means of surgical stapling devices has achieved popularity in the last decade even though no detailed study has been reported comparing complications following the stapled anastomosis with those following hand sutured procedures performed by the same surgeons. We have reviewed 812 operative procedures on the gastrointestinal tract performed in one hospital over a four year period. Stapled anastomoses were performed in 472 with 13 (2.8%) complications related to the anastomosis; in 296 sutured anastomoses there were nine (3.0%) related complications. Comparison did not disclose any significant difference in the number of complications in these two groups. In 44 instances wherein the anastomosis contained both staples and sutures, there were no related complications. Further analysis of the patients in each group disclosed that stapling procedures were utilized in a much higher percentage of those operations which were performed under emergency conditions or in the presence of intra-abdominal sepsis, intestinal obstruction, and carcinomatosis. If the technical details of surgical stapling are mastered, this technique appears to be as safe as suturing in the performance of anastomoses in the gastrointestinal tract.

Colectomy↗
PubMed1976

Abdominoperineal resection following anterior resection.

A series of 11 patients undergoing abdoninoperineal resection for "suture line recurrence" following anterior resection is presented. Five-year survival is 10%. Technically, the procedure is difficult and major problems are encountered, including large blood loss and ureteral complications. These patients had an inadequate distal margin of resection at the time of anterior resection. The survival of this group of patients underscores the importance of making the correct judgment about anterior or abdominoperineal resection at the time of the initial presentation of the patient. The phrase "suture line recurrence" is a misnomer; all of these patients had advanced pelvic malignancy. If the adequacy of the distal margin is questionable or a distal margin of 5 cm cannot be obtained safely at the time of anterior resection, abdominoperineal resection should be performed, as the opportunity for cure of a recurrence should this rule be compromised is limited.

Female↗
PubMed2004

Arthroscopic supraspinatus tendon repair using suture anchors and a modified Mason-Allen technique: an intra-articular approach.

Abstract Arthroscopic repair of supraspinatus tendon tears has had clinical results comparable to those of open procedures. The arthroscopic subacromial approach is well described in the literature but is still limited to skilled arthroscopic surgeons owing to the technical difficulties of the method. We present an intra-articular approach for supraspinatus tendon repair using suture anchors and a modified Mason-Allen technique. A major advantage of this technique is an excellent visualization of the procedure that optimizes the preparation of the lesion, positioning of the suture anchors, and, especially, grasping of the tendon with suture devices. The easy and exact positioning of the sutures allows creation of a modified arthroscopic Mason-Allen stitch. The result is a very stable initial tendon-to-bone fixation, which is necessary for a sufficient osteofibroblastic integration.

Arthroscopy↗
PubMed1990

Implantation of scleral-fixated posterior chamber intraocular lenses.

A surgical technique for implanting a posterior chamber intraocular lens (IOL) in eyes without capsular or zonular support is presented. A 10-0 polypropylene suture attached to a standard needle is tied to the apex of each haptic and passed transclerally through the ciliary sulcus to secure the haptics at the 3 o'clock and 9 o'clock meridians. This technique produced good visual results in six aphakic patients who were contact lens intolerant, two patients in whom capsular or zonular rupture at the time of cataract surgery precluded standard nonsuture fixation techniques, one patient who had intracapsular cataract extraction for a subluxated, cataractous lens, and one patient who had secondary IOL implantation in combination with penetrating keratoplasty for aphakic bullous keratopathy. Advantages over other techniques of posterior chamber lens implantation in the absence of capsular support include technical ease, avoidance of iris fixation, and more precise placement of scleral fixation sutures, thus minimizing IOL decentration.

Adult↗
PubMed1992

[Role of deep temporal lift in the surgical treatment of face aging].

This is a new technique which is completely different from superficial temporal facelift also referred to as the mannequin facelift, which is associated with well known failures and sequelae. The principle of the deep temporal facelift is to approach the deep surface of the musculoaponeurotic plane by remaining in contact with the bone and to attach the ascension of this plane by means of sutures anchored to the temporalis mucsle and fibrin glue. This operation is technically possible due to the use of the dissectable space described by Rouvière between the galea and the temporalis muscle. This virtual, detachable space can only be easily defined by the use of hydrodissection. It is an avascular space with the exception of an unnamed vein located at the external agnle of the orbit. There is no resection of the scalp, no modification of the hairline and no modification of the sideburns. The frontal branch of the facial nerve constitutes the anatomical danger. It is situated anterior to the superficial temporoparietal aponeurosis which prolongs the galea. The two danger zones are the zygomatic arch which is crossed by the frontal nerve trunk and a quadrilateral area between the hairline and the tail of the eyebrow and a vertical line 1.5 cm lateral to the lateral canthus of the eye. The frontal nerve does not constitute any risk during deep temporal facelift, as this procedure remains about 1.5 cm away from the zygomatic arch. The nerve is obviously more superficial in the quadrilateral area. To avoid damaging it, the dissection must be performed under direct vision using a cold light, remaining in contact with the temporalis aponeurosis and avoiding any untimely instrumental manoeuvre between a subaponeurotic metallic instrument and the stretched skin. This technique causes minimal discomfort to the patient. It can be performed under local or general anaesthesia. The hospital stay is brief and the postoperative course is extremely straightforward with a very limited risk of bruising. The deep temporal facelift can be combined with the subpalpebral facelift in order to act on the upper 2/3 of the face. Its essential indications are: drooping of the tail of the eyebrow, drooping of the external canthus of the eye, erows feet.

Eyelids↗
PubMed1982

Clinical efficacy of the stapled anastomosis in esophageal reconstruction.

We have clinically evaluated Russian and American stapling devices used for esophageal reconstruction and compared the results following stapled anastomosis with those following hand-sutured procedures, both performed by the same surgeon. With the Russian stapler, anastomoses performed in 17 patients with carcinoma of the thoracic esophagus resulted in only one (5.9%) anastomotic leak; in 12 hand-sutured anastomoses and in 11 anastomoses done with an American stapler, no anastomotic complication occurred. Thus, a long gastric tube with good blood supply is of paramount importance, and if the technical details of surgical stapling can be overcome, a stapled anastomosis appears to be as safe as a manual suturing for patients undergoing esophageal reconstruction.

Esophageal Neoplasms↗
PubMed1994

Improvement of Minilaparotomy Technique to Allow for Reversal of Extensive Sterilization Procedures

In a previous study of outpatient reversal of tubal sterilization by a combined approach of laparoscopy and minilaparotomy, postoperative intrauterine pregnancy rates were 71%, and total costs were 40% lower than for those women undergoing anastomosis by a traditional laparotomy. However, the technique, which involved exteriorization of the uterus and adnexa, could not be easily applied when difficult cases with little remaining oviduct were encountered. With a modification of technique and the addition of a new retractor, it became feasible to consider more difficult cases for minilaparotomy outpatient reversal of sterilization. We prospectively studied 11 such patients with weight < IBW + 30% and < 4 cm of operable oviduct for technical feasibility, cost, complication rates, and reproductive outcome. A vaginal pack was used to elevate the uterus and a Babcock clamp was used to bring the fundus toward the incision by traction on the round ligament. A small self-retaining retractor designed for back surgery (Cloward retractor) was used for the abdominal wall. With the aid of an operating microscope a two-layer anastomosis was performed with 7-0 and 9-0 polydiaxone sutures. In all cases minilaparotomy reversal of tubal sterilization could be performed without prolonged technical difficulty. The mean age of the patients was 34.1 years (range 25-41 years) and operating time 110 minutes (87-158 min). There were no intraoperative or perioperative complications during the same day hospitalization. The mean time of follow-up was 16.7 months. Postoperatively, five women had ongoing or delivered pregnancies (45%) and one woman had two ectopic pregnancies. This study demonstrated a method for outpatient reversal of extensive tubal sterilization which was technically feasible in the 11 attempted patients. Based on the preliminary data from this study we encourage patients who have had extensive tubal sterilization procedures to consider both outpatient, minilaparotomy anastomosis and IVF as reasonable alternatives.

Journal Article↗
PubMedDate not supplied

Doubly-armed short sutures are useful for microsurgical hepatic artery reconstruction in living-related liver transplantation.

Although microsurgical hepatic artery reconstruction has become the essential technique in pediatric and living-related liver transplantation, it remains a technical challenge. We describe here our microsurgical hepatic artery reconstruction technique in living-related liver transplantation using a doubly-armed short suture. From August 1998 to March 1999, 8 patients underwent living-related liver transplantation at the Kyushu University. For these 8 patients, microsurgical reconstruction with doubly-armed short sutures were undertaken. After preparing the operative field for microsurgery, operative microscopy with a continuous zoom magnification is introduced. Interrupted sutures using doubly-armed short sutures are performed in a biangular stay-sutured method with a double clip. None of the 8 patients developed hepatic artery thrombosis. We conclude that the use of doubly-armed sutures allows safe and reliable in microsurgical hepatic artery reconstruction in living related liver transplantation.

Adolescent↗
PubMed1989

Comparison between fibrin tissue adhesive, epineural suture and natural union in intratemporal facial nerve of cats.

Our objective was to study intratemporal anastomosis of the facial nerve in cats. Clinical, electrophysiological and histological results of the use of fibrin tissue adhesive, epineural suture and natural adhesion were compared. The 30 adult cats studied had undergone mastoidectomy exposure, and section of the facial nerve 1 cm before its exit from the stylomastoid foramen. Anastomosis was then undertaken, using epineural suture combined with stabilization through fibrinic tissue adhesive, and union of the stumps without stabilizing them. Each type of anastomosis was carried out in 10 animals. Clinical, electrophysiological and histological assessments of both the site of anastomosis and the ventral branch of the facial nerve followed the aforementioned procedures. By means of statistical analysis, the authors reached the following conclusions: 1) Considering the clinical assessment per se, both groups with fibrinic tissue adhesive and suture showed similar features and results, which in both cases were better than those following natural union. 2) Considering the electrophysiological results per se, the use of fibrin tissue adhesive was superior to any other method used. 3) Considering the histological examination per se, both groups with fibrin tissue adhesive and suture revealed similar features which were more favourable than those shown by natural union. 4) In the overall comparison of the various parameters in the three groups, the use of fibrin tissue adhesive achieved better results than any other method. Based on the results of this study, the authors conclude that the use of fibrin tissue adhesive has technical advantages, and that the results of this use outweigh those achieved with both epineural suture and natural union. The authors recommend this technique as the most beneficial to be resorted to, for intrapetrous anastomosis of the facial nerve.

Anastomosis, Surgical↗
PubMed1989

Alternatives to packing in septorhinoplasty.

Nasal packing is considered routine by most physicians and patients at the completion of nasal and septal surgery. Yet the rationale for this maneuver is not clearly defined by reported investigation or logical analysis. We discuss 75 consecutive nasal surgical procedures completed without packing. There were two postoperative episodes of bleeding, both from pyriform aperture incisions for lateral osteotomy and both managed in the recovery room with an absorbable gelatin sponge. Technical refinements such as scrupulous preoperative history taking, through-and-through suturing of the entire septal flaps, small-caliber osteotomy, meticulous closure of all intranasal incisions, and proper application of a conforming dressing are essential for hemostasis. We offer specific procedural guidance to minimize the risk of postoperative nasal bleeding.

Adolescent↗
PubMed1990

Variability of measurements of cranial growth in the rabbit.

This study concerns techniques used in experimental cranial growth research: roentgen cephalometry, roentgen stereophotogrammetry, and gross measurements (osteometry). A comparison of the precision of these methods has not been found in the literature. Computation of technical errors is fundamental to the sound evaluation of registered findings, and such a presentation must be obligatory in all biometric reports. We compared the measurement error of roentgen cephalometric and osteometric data with that obtained by roentgen stereophotogrammetry (RSA). RSA demonstrates a superior replicability, and this technique gives possibilities for kinematic and volumetric determinations simultaneously with distance evaluation. Roentgen cephalometry has the advantage of enabling distance and angular measurements between any well-defined skeletal points or lines. This technique, preferably after implantation of bone markers, is a reliable alternative, but optimal results necessitates calculations of the magnification factor for each bone segment involved. Direct osteometry does not contribute additional information, but problems of image magnification are omitted. Preferably, one individual should perform all measurements regardless of the method used. Growth rates and values calculated by one technique cannot be directly transformed to some other approach. In all probability, assessments of distance changes would gain substantially by using one technical approach consistently throughout actual age intervals. The least variable measurements of sutural growth are made for sutures growing primarily in one plane and with substantial growth rates. One must realize that differences among studies may be due to the limitations of, in particular, the cephalometric and osteometric techniques.

Animals↗
PubMed1977

Microsurgical techniques in free flap reconstruction.

Free flap reconstruction is discussed with emphasis on microsurgical technique utilized in union of blood vessels 1 mm in external diameter. Proper microsurgical instrumentation, magnification and small vessel suture technique are all of importance in achieving a successful microvascular anastomosis. Technical maneuvers employed in identifying and avoiding small vessel thrombosis are presented. Surgical techniques, as presented here, have allowed us to successfully use free flaps to reconstruct large oral cavity defects following ablative cancer operations.

Blood Coagulation↗
PubMed2004

Delayed repair of large myelomeningoceles.

INTRODUCTION: Repair of myelomeningoceles larger than 5 cm in diameter is not easy. We describe a simple technique. PATIENTS AND METHODS: The patients with a large myelomeningocele sac were included in this study. Ten patients with a large myelomeningocele underwent surgical repair using this technique. The skin was incised in the midline proximal to the myelomeningocele sac. The incision was carried caudally and away from the midline to open the sac after identifying the fascia. The incision is carried circumferentially around the neural placode and the skin is saved as much as possible. About a 1-cm-width of the dura mater beneath the skin is left to ease the subcutaneous suturing. The dura is sutured in the midline. The skin is undermined bilaterally in the plane between the muscle and subcutaneous fat and closed with interrupted sutures in the midline. CONCLUSION: This simple technique is appropriate for the closure of large myelomeningoceles and does not need more extensive and complex procedures.

Child, Preschool↗