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At least 1,639 records · Page 91Linked to original sources
PubMed2003

Laparoscopic partial nephrectomy: a new horizon.

PURPOSE OF REVIEW: The widespread use of available imaging techniques has resulted in an increased detection of incidental small renal tumors. For these small tumors, there has been a definite trend towards nephron-sparing surgery over the past decade. RECENT FINDINGS: With increasing experience, advanced ablative and complex reconstructive procedures are now being performed laparoscopically. Laparoscopic partial nephrectomy has lagged behind while laparoscopic radical nephrectomy is widely practiced and has become an established procedure. This lag is largely due to the technical difficulty in achieving renal hypothermia and securing renal parenchymal hemostasis. SUMMARY: Advanced laparoscopic suturing skills and the availability of laparoscopic vascular instruments have allowed laparoscopic partial nephrectomy to become a viable option for select patients, wherein laparoscopic partial nephrectomy attempts to duplicate traditional, established open surgical techniques.

Clinical Trials as Topic↗
PubMed2004

The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients.

Nasal tip surgery has become significantly more complex since the introduction of tip grafting and the many suture designs that followed the resurgence of open rhinoplasty. Independent of the surgeon's technical approach, however, is the need to identify the critical anatomical characteristics that will make nasal tip surgery successful. It is the author's contention that only two such features require mandatory preoperative identification: (1) whether the tip is adequately projecting and (2) whether the alar cartilage lateral crura are orthotopic or cephalically rotated ("malpositioned"). Data were generated from a review of 100 consecutive primary rhinoplasty patients on whom the author had operated. The results indicate that only 33 percent of the entire group had adequate preoperative tip projection and only 54 percent had orthotopic lateral crura (axes toward the lateral canthi). Forty-six percent of the patients had lateral crura that were cephalically rotated (axes toward the medial canthi). Both inadequate tip projection and convex lateral crura were more common among patients with malpositioned lateral crura (78 percent and 61 percent) than in patients with orthotopic lateral crura (57 percent and 20 percent, respectively). Tip projection can be reliably assessed by the relationship of the tip lobule to the septal angle. Malposition is characterized by abnormal lateral crural axes, long alar creases that extend to the nostril rims, alar wall hollows, frequent nostril deformities, and associated external valvular incompetence. The data suggest that the surgeon treating the average spectrum of primary rhinoplasty patients will see a majority (61 percent) who need increased tip support and a significant number (46 percent) with an anatomical variant (alar cartilage malposition) that places these patients at special risk for postoperative functional impairment. Correction of external valvular incompetence doubles nasal airflow in most patients. As few as 23 percent of primary rhinoplasty patients (the number with orthotopic, projecting alar cartilages in this series) may be proper candidates for reduction-only tip procedures. When tip projection and lateral crural orientation are accurately determined before surgery, nasal tip surgery can proceed successfully and secondary deformities can be avoided.

Adolescent↗
PubMed2003

A percutaneous approach to deep venous valve insufficiency with a new self-expanding venous frame valve.

PURPOSE: To ascertain if a percutaneously delivered venous valve bioprosthesis (PVVB) can be implanted in the porcine venous system and function without complications. METHODS: The PVVB is a glutaraldehyde-preserved, valve-bearing venous xenograft sutured inside a memory-coded nitinol frame (diameter 10, 12, or 14 mm). In 10 50-kg pigs, the external jugular vein was exposed, and a 16-F introducer sheath was positioned in the common iliac vein. One PVVB was inserted and deployed in each iliac vein under fluoroscopic control. After PVVB implantation, all animals were randomly given either vitamin K antagonists (1-2 mg/d) (group I) or a combination of aspirin (150 mg/d) and clopidogrel (75 mg/d) (group II), which were shown in a preliminary pilot study to be the most effective anticoagulation regimens in the pig model. Ascending and descending completion phlebograms were performed. PVVBs were evaluated with phlebography at 4 weeks to assess patency and competence; all PVVBs were explanted and processed for histological analysis. RESULTS: In 8 animals, the PVVB was successfully deployed in both the left and right iliac veins. In 2 pigs, only 1 PVVB was inserted due to vascular anomalies. Completion phlebography demonstrated 18 patent and competent valves. At 2 weeks, bleeding complications occurred in 3 group I pigs; all 5 animals were terminated to prevent further complications. Of the 8 valves in this group, 7 were patent (3 competent) by phlebography; 1 PVVB had migrated due to known undersizing of the stent frame. At 4 weeks, group II (5 pigs, 10 valves) analysis revealed 5 patent (3 competent) valves; no bleeding complications occurred in this group. Histology showed thrombosis as the cause of occlusion in all 5 non-patent valves from group II. CONCLUSIONS: Deployment of a glutaraldehyde-fixed bovine vein sutured to a self-expanding nitinol stent in the porcine iliac vein is technically feasible. Development of a venous bioprosthesis that can be placed percutaneously may have important clinical applications as an endovascular treatment for chronic venous insufficiency when it is due to valvular incompetence.

Animals↗
PubMed2006

Iliac anastomotic stenting with a biodegradable poly-L-lactide stent: a preliminary study after 1 and 6 weeks.

PURPOSE: To assess the technical feasibility, thrombogenicity, and biocompatibility of a new biodegradable poly-L-lactic acid (PLLA) anastomotic stent. METHODS: A polytetrafluoroethylene bifurcated graft was implanted in 17 pigs through a midline abdominal incision. After transverse graft incision, 17 316L stainless steel stents and 17 PLLA stents were randomly implanted at both iliac anastomotic sites and deployed with a 6-mm balloon under direct vision without angiography. Intended follow-up was 1 week in 6 pigs receiving oral acetylsalicylic acid (ASA) and in 7 pigs receiving ASA/clopidogrel; 4 pigs receiving ASA/clopidogrel were followed for 6 weeks. At the end of the study, the segments containing the stents were surgically explanted and processed for histology to measure the mean luminal diameter, intimal thickness, and the vascular injury and inflammation scores. RESULTS: Initial technical success of stent placement was achieved in all animals without rupture of the suture. Two pigs died (unrelated to the stent) at 3 days after operation (1 in groups A and B). At 1 week, all PLLA stents showed thrombotic occlusion with the use of ASA alone. In contrast, all PLLA stents remained patent with concurrent administration of ASA/clopidogrel. All metal stents were patent regardless of the antiplatelet regimen. The mean luminal diameter of patent PLLA stents (4.13+/-0.17 mm) was comparable to metal stents (4.27+/-0.35 mm, p=0.78) at 1 week, but significantly diminished at 6 weeks (3.21+/-0.44 versus 4.19+/-0.18 mm, p=0.005). Histological analysis showed no signs of excessive recoil. PLLA stents induced a higher inflammation score (1.79+/-0.56) and more intimal hyperplasia (0.34+/-0.11 mm) compared to metal stents [1.27+/-0.44 mm (p<0.001) and 0.18+/-0.04 mm (p=0.006), respectively] at 6 weeks. Vascular injury was comparable between PLLA and metal stents. CONCLUSION: Biodegradable PLLA stents showed higher thrombogenicity and reduced patency compared to metal stents during early follow-up. Although ASA and clopidogrel prevented thrombotic occlusion, the increased inflammatory response and neointima formation remain major concerns of PLLA stents. A solution to this problem might be the incorporation of anti-inflammatory drugs into the PLLA stent.

Absorbable Implants↗
PubMed2000

Submucosa of canine small intestine as an alternative medium-diameter autogenous arterial graft.

BACKGROUND: Small intestinal canine submucosa has been used in previous studies as a large diameter arterial graft and has shown acceptable patency rates. The aim of our experimental study was to assess its effectiveness when it is used as an autogenous medium-sized diameter arterial graft (5-7 mm). METHODS: Fifteen mongrel dogs were included and underwent laparotomy under general anaesthesia. The mucosa, tunica muscularis and serosa were removed from a resected intestinal segment. The remaining tube, which consisted of the submucosa and the basilar tunica mucosa, represented the experimental graft which was used to replace a proportional gap of the canine infrarenal aorta. Ascertainment of peripheral pulses, measurement of the intra-aortic pressures, aortography and in vivo/in situ observation before the sacrifice of the animals, were the procedures used for verification of the graft's patency. RESULTS: The resistance to thrombogenicity of the graft was considered satisfactory: nine out of 10 grafts remained patent for postoperative intervals ranging from one day to one year; one graft showed partial obstruction due to a technical perioperative error. The grafts showed also excellent physical characteristics (ease of handling and suturing, blood impermeability and durability), resistance to infection and showed no tendency to develop myointimal hyperplasia. CONCLUSIONS: Small intestinal canine submucosa showed satisfactory haemodynamic properties, long-term patency and resistance to infection, when used as a medium-diameter arterial substitute.

Animals↗
PubMed1992

[Salvage heart surgery after percutaneous mitral valvuloplasty].

Percutaneous mitral valvuloplasty (PMV) for selected patients with symptomatic mitral stenosis (MS) has been proposed as a safe alternative to open mitral commissurotomy (OMC) or mitral valvular replacement (MVR). Among 146 consecutive patients undergoing PMV from March 1987 to April 1990, 18 (12%) needed urgent (8) or delayed (10) (average 7 days) corrective surgery following PMV. There were 15 women and 3 men, with a clinical incapacity class II (3) or III (15), and with an intermediate risk for PMV according to echo score (mean = 8). The indications for corrective surgery were: massive mitral regurgitation due to tearing of the anterior leaflet (6), cardiac perforations (left atrium in 2, left ventricle in 3), PMV technical failure (5), severe atrial shunting (2). Operative procedures included MVR (14), cardiac wound suturing only (3), OMC (1). Operative mortality (30 days) was 22% (4/18), equally distributed among the urgent and delayed group. The causes of postoperative death were hemorrhage (2), severe cerebral ischemia (1) and sudden death (1). Compared to operative mortality after OMC (0/17.0%) or MVR (1/32, 3.1%) as the initial treatment for MS during the same time period, cardiac operation after failed or complicated PMV carried a significantly higher mortality (p = 0.004). Therefore, optimal patient selection and aggressive corrective surgery are necessary to decrease the PMV related mortality and morbidity.

Adult↗
PubMed2004

[Laparoscopic splenectomy in a general surgery department of a hospital].

The results of treatment of 32 patients with spleen diseases who have undergone laparoscopic splenectomy (LSE) are analyzed. Surgery was performed most often for idiopathic thrombocytopenic purpura. Some technical features of surgery are discussed. It is demonstrated that high-technology methods (suturing device "EndoGia", electrosurgical unit "LigaSure") increase reliability of hemostasis, decrease blood loss during surgery and reduce time of surgery. Complications during surgery were seen in 3 (9.3%) cases, conversion - in 2 (6.3%). Mean time of surgery was 121.3 min, mean blood loss - 346 ml, postoperative complications were seen in 4 (12.5%) patients, mean hospital stay - 5.7 days. There were no lethal outcomes. It is concluded that LSE is safe and effective procedure reducing rate of infectious and hemorrhagic complications after surgery.

Adult↗
PubMed1991

The surgical repair of a defect of tendinous distortion of the patella and of the joint capsule during an arthrolysis of the knee joint.

The suture of tissues resected during surgical tendomyolysis and arthrolysis of the knee joint required by its extension contracture is carried out during tibial flexion at an angle of 90 degrees. This can lead to the development of a diastasis of the tendinous distortion of the patella and of the joint capsule which prevents the suture of the wound. It is suggested to repair the resulting tissue defect with the use of a split flap of local tissues with a wide base situated in front of the defect. The flap is dissected from the lateral part of the tendinous distortion and of the capsule. The flap is turned by 180 degrees around its base and extended to cover the defect with its subsequent suture to the opposite edge of the defect. The described supplementary surgical procedure is technically uncomplicated and results in stable anterior and lateral joint structures, in a reduction of the risk of complications due to infection, and allows an early initiation of active kinesitherapy in the early postoperative period.

Contracture↗
PubMed1991

[Temporomandibular joint arthroscopy. Therapeutic aspects].

Arthroscopy is an interesting and enlarging technique that visualise the temporomandibular joint and allows surgical technics such as lysis and lavage, prediscal section, retrodiscal cauterisation, oblic protuberance cauterisation, disc suturing or shavering of the articular surfaces.

Arthroscopes↗
PubMed1984

[Vagotomy in bleeding ulcer of the duodenum].

The authors have analyzed immediate and late results of the surgical treatment of 162 patients. Organ-preserving operations are thought to be inferior to parcimonious resections of the stomach with vagotomy in reliability of arrest of bleeding and prevention of recurrences. Sphincter-destroying operations are believed to be expedient if the ulcer can be technically dissected both at the height of bleeding and in the intermediate (cold) period. Suturing of the ulcer is possible in patients with high operative risk.

Duodenal Ulcer↗
PubMed1998

[Isolated defect injuries of the common femoral and external pelvic veins].

The author describes the case-history of an injury of the common femoral and external pelvic vein. He describes the method of replacement of the loss using an autovenous graft formed from the trunk of the vena saphena magna which was split longitudinally and then sutured in a spiral fashion. The applied reconstruction method can be evaluated as reliable, technically feasible. The reconstruction is patent after two years and the affected extremity bears no signs of venostasis.

Accidents, Traffic↗
PubMed2000

Lessons learned from laser tissue soldering and fibrin glue pyeloplasty in an in vivo porcine model.

PURPOSE: We compared sutured pyeloplasty to 2 newer techniques of tissue anastomosis, including laser soldered pyeloplasty using a diode laser with 50% albumin solder mixed with indocyanine green and fibrin glue. MATERIALS AND METHODS: We performed 53 pyeloplasties in 50 pigs using suture, laser or fibrin glue. In the immediate group anastomotic leak pressure was measured immediately postoperatively, and then animals were euthanized. At 1, 3 and 4 weeks postoperatively a pressure flow study at 10 cc per minute in cm. H2O was performed, and tissue was sent for histological and collagen content analysis. RESULTS: In the immediate studies laser soldering achieved a significantly higher mean anastomotic leak pressure (50.5 +/- 15.1 cm. H2O) than sutured (17.3 +/- 5.4) or fibrin glued (3.5 +/- 1.5) repairs. In the 1, 2 and 4-week studies animals in the sutured pyeloplasty group had no complications, and all pressure flow studies except 1 were normal. However, in the laser soldered groups we observed 8 urinomas in 19 animals, and most occurred during the first part of our study. This complication was prevented by stopping urine flow at the anastomotic site at laser irradiation and by improving application of the solder. Of the 11 animals in which pressure flow studies were performed only 2 were obstructed. Of the 7 chronic fibrin glue group 4 animals had urinomas and 2 had unobstructed pressure flow studies. Histological studies and immunohistochemical staining for collagen showed no differences in collagen distribution among the 3 procedures. CONCLUSIONS: Laser soldering and fibrin glue pyeloplasties are not superior in the long-term compared to sutured pyeloplasty. Fibrin glue in our animal model had the highest failure rate. Further improvements in the technical aspect of laser tissue welding need to be made to benefit from its theoretical advantages in minimally invasive surgery.

Anastomosis, Surgical↗
PubMed1989

Carotid eversion endarterectomy revisited.

Carotid eversion endarterectomy appears to be a safe and anatomically acceptable alternative to the standard carotid bifurcation endarterectomy, as evidenced by the absence of permanent neurologic morbidity and mortality in 98 operations. Preliminary clinical, angiographic, and noninvasive laboratory parameters suggest that there is a significant reduction of both residual technical defects and early recurrent stenosis. Specifically, no perioperative thrombosis or early restenosis was encountered in the 98 endarterectomies. Furthermore, only two technical defects have been noted, and one of these occurred in one patient who required a longitudinal arteriotomy and attendant suture line when the common carotid artery was transected too proximally and the eversion maneuver could not be accomplished. Serial long-term clinical and noninvasive laboratory follow-up evaluation, in addition to indicated postoperative angiography, will continue in an effort to assess the durability of a technical approach to carotid endarterectomy that may minimize residual defects and early restenosis.

Adult↗
PubMed1984

Stapled esophagogastric anastomosis.

In a consecutive, nonrandomized series of 92 patients, esophagogastric anastomosis was performed with a suture technique in 32 patients and with a stapler in 60 patients. Only one anastomotic leak occurred in each group. Stricture later formed in three sutured anastomoses and in eight of the stapled anastomoses. A review of published reports shows anastomotic leak in 3.5 percent of the patients with stapled anastomoses. In patients with sutured anastomoses, leak occurred in approximately 10 percent. The improved results with the stapler do not alter the necessity for meticulous attention to technical detail.

Dilatation↗
PubMed1995

A new model of experimental cerebral infarction in New Zealand white rabbits.

To develop an easy, reproducible experimental model of cerebral infarction (CI) without craniotomy in New Zealand white rabbits, a silicone rubber cylinder embedded in a nylon suture was delivered to the middle cerebral arteries through the internal carotid artery in anesthetized animals. Rabbits were sacrificed 0.5-5 h after embolization. CI size and location were ascertained by the triphenyl-2H-tetrazolium chloride (TTC) staining method; cerebral blood flow (CBF) was measured prior to and after embolization. PCO2, temperature and blood pressure were monitored and kept constant. CI occurred in all rabbits after 4 h of ischemia, in 50% after 3 h and only in 33% after 2.5 h. CI did not occur within less than 2.5 h of ischemia. No correlation was found between size and location of CI and occlusion time. CBF was maximally reduced in the right MCA territory but was also reduced in both anterior cerebral arteries and left MCA territories. This model is technically easy and the retrievable embolus allows the study of reperfusion by pulling on the nylon suture. It is suitable for studying chemical and molecular changes of the ischemic cells and/or for studying neuroimage changes after ischemic stroke.

Animals↗